The following is the summary of “Perspective: the top 11 priorities to improve trauma outcomes, from system to patient level” published in the December 2022 issue of Critical care by Reade, et al.
Numerous training courses across the world use the Haemorrhage, Airway, Breathing, Circulation, Disability, Exposure/Environmental Control approach to individual patient management in trauma. Interventions at the system level for prevention and quality improvement, as well as a nuanced approach to clinical innovation, are likely to lead to further enhancements in trauma outcomes.
The top 11 priorities for those working across the spectrum of trauma care, from policymakers to clinicians, should be based on a narrative review of remaining preventable mortality and morbidity in trauma: investment in effective trauma prevention (likely the most cost-effective intervention); prioritization of resources, quality improvement, and innovation in prehospital care (where the most preventable mortality remains); The most important steps in modern damage control surgery are as follows: assembling a top-notch trauma team; using proven clinical interventions to control bleeding, open and protect the airway, and maximize breathing; preserving a healthy blood volume and checking on the heart’s performance; acknowledging the importance of the intensive care unit in the aftermath of a trauma; and recognizing the value of early mobilization to the intensive care unit. Putting an emphasis on effective intercurrent treatment in the critical care unit, particularly prevention for thromboembolic disease; performing a comprehensive tertiary survey, with the understanding that about 15% of injuries are typically discovered in the intensive care unit; Improvements in clinical trial design, quality assurance, and early extubation are discussed in points.
A comprehensive strategy to trauma quality and process improvement has been shown to be effective, as evidenced by the dramatic decline in population trauma mortality and injury case fatality rate over the past few decades. It is imperative that clinicians and policymakers continue to pay close attention to these tenets, with a particular focus on the areas with the largest remaining preventable mortality and a priority on functional outcomes.