Anest. intenziv. Med. 2024;35(2):89-97 | DOI: 10.36290/aim.2024.020

Management of patients with trauma in the Czech Republic - results of a questionnaire study across 12 trauma centers for adultsOriginal Article

Holubová G.^{1, 2}, Vymazal T.¹, Beitl E.³, Dráč P.⁴, Edelmann K.⁵, Gürlich R.⁶, Jícha Z.⁷, Kloub M.⁸, Kočí J.⁹, Krtička M.¹⁰, Menšík P.¹¹, Pavelka T.¹², Matějka J.¹², Pleva L.¹³, Šír M.¹³, Šrám J.¹⁴, Durila M.^{1, 2}

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny 2. LF UK a FN Motol, Praha

² Zdravotnická záchranná služba hl. m. Prahy

³ I. ortopedická klinika 1. LF UK a FN Motol, Praha

⁴ Traumatologická klinika Fakultní nemocnice Olomouc

⁵ Klinika úrazové chirurgie Fakulty zdravotních studií Univerzity J. E. Purkyně v Ústí nad Labem a Krajské zdravotní, a. s. - Masarykovy nemocnice v Ústí nad Labem, o. z.

⁶ Chirurgická klinika 3. LF UK a FNKV, Praha

⁷ Traumatologické centrum UVN­‑VFN Praha

⁸ Oddělení úrazové chirurgie Nemocnice České Budějovice, a. s.

⁹ Klinika urgentní medicíny Fakultní nemocnice Hradec Králové

¹⁰ Klinika úrazové chirurgie FN Brno a LF MU, Brno

¹¹ Traumatologické oddělení Krajská nemocnice Tomáše Bati ve Zlíně

¹² Klinika ortopedie a traumatologie Fakultní nemocnice Plzeň

¹³ Klinika úrazové chirurgie a ortopedie Fakultní nemocnice Ostrava

¹⁴ Traumatologicko­‑ortopedické centrum Krajská nemocnice Liberec, a. s.

Despite the existence of many guidelines in the management of trauma, trauma is still the leading cause of death in young age groups, and mortality has not decreased in the Czech Republic over the past 10 years. The issues of circulatory stability, indications for the administration of whole blood, routine use of imaging methods, and prioritization of individual care steps are still not clearly defined. We decided to use a questionnaire study to map what the initial care of traumatized patients looks like across our country in 12 trauma centers and to define the circulatory stability of the patient, on which the sequence of individual diagnostic and therapeutic steps is built.

Methodology: We created a questionnaire-based multicenter study and addressed the clinical workplaces of all trauma centers in the Czech Republic. The questions were focused on the procedure for treating traumatized patients. In May 2022, the questionnaire was sent to the leading physicians of all 12 trauma centers in the Czech Republic, according to the current Bulletin of the Ministry of Health. Additional questions were created based on the answers. The leading physicians of the trauma centers answered at their discretion regarding the current situation at their workplace. We processed the answers obtained using descriptive statistics.

Results: In eight centers, the head of the trauma team is a traumatologist. Most often (in four centers), a trauma team comprises six people. Only five centers administer whole blood, although seven of the 12 centers believe it has an indication for administration in traumatized patients. Circulatory stability can be defined as a systolic pressure above 80-90 mmHg without vasopressors and a heart rate below 120/min; borderline stability as a condition where vasopressor support is needed to maintain the systolic blood pressure above 80-90 mmHg, and heart rate is 120-130/min and instability when even the use of vasopressors does not lead to maintain stable systolic pressure above 80-90 mmHg, and heart rate is above 130/min. Eight workplaces have CT scans as part of the emergency department, and routine X-rays of the chest, pelvis, and E-FAST (Extended Focused Assessment with Sonography in Trauma) are performed by only three sites. All 12 centers are inclined to use a CT scan at FAST positive circulatory stable patients, and four centers even in borderline stable patients to establish a definitive diagnosis. All centers can perform chest drainage in the emergency department; ten centers perform emergency thoracotomy, and four centers perform laparotomy. Only three centers use the REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) catheter in the emergency room.

Conclusion: Despite certain variability in trauma care management across the Czech Republic, the concepts of circulating stability, boundary stability, and instability are common to all trauma centers. These concepts can be used in further professional discussions to optimize the management of this group of patients.

Keywords: ATLS, whole­‑body CT, FAST, whole blood, trauma, REBOA.

Received: August 17, 2023; Revised: April 7, 2024; Accepted: May 2, 2024; Prepublished online: May 22, 2024; Published: June 24, 2024  Show citation