Critical Care Issues in the Early Management of Severe Trauma

Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Orga-nization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year. Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34 % to 50 % occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76 % [4] and as low as 1 % in mature trauma systems [5,6]. Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), tech-nique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30 % of 125 trauma deaths with errors. These errors contributed to 48 % of all preventable deaths