The Application of Advanced Trauma Life Support

7/23/2019 The Application of Advanced Trauma Life Support

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The Application of Advanced Trauma Life Support (ATLS) in

Casualty Department in Al-Kindy Teaching Hospital Does it

change rate of mortality!

"idha #a$ad Kadhim Al-%asri CA%S&

A%ST"ACT

%ac'ground Advanced Trauma Life Support (ATLS) was

developed in the United States in the 1970s to provide a

standardized method for the initial assessment and treatment of

severel in!ured victims " phsicians wor#in$ in %mer$enc

&epartments (%&s)' The concept "ased on the principles treat *rst

what #ills *rst+ and do no further harm+ was initiall meant for

doctors who are not alread e,perienced with care of ma!or trauma

victims

*+ectives The aim of this stud is to demonstrate an

di-erence in mortalit amon$ trauma patients in Al./ind Teachin$

ospital (/T) "efore (pre.ATLS) after (post.ATLS) application of

ATLS principles'

,atients .ethods This stud involves(12997) trauma

patients admitted to 3asualt &epartment (3&) in /T durin$ the

ear 2004(pre.ATLS period) of (4294) trauma patients admitted to

same 3& durin$ the ear 2010(post.ATLS period)' The data was

collected retrospectivel and analzed to see if the results are

statisticall si$ni*cant " applin$p-value(if P-value5 0'06 it is

considered statisticall si$ni*cant)'

"esults n ear 2004 (pre.ATLS period) total num"er of

patients was (12997)' There were 868 males (60'6:) 6261

females (;0';:) 114 children (9'1:)um"er of total deaths was 191 (2':) num"er of

male deaths was 1;6(76'918:) num"er of female deaths was

;0(20'9;2:) num"er of child deaths was 8('1;1:)'

Conclusion ?ur stud demonstrates that introduction of theATLS pro$ram si$ni*cantl improvedthe outcome and decrease


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mortalit in trauma patient admitted to 3&s in ra@i hospitals' t alsoimproves the performance of doctors wor#in$ in 3&s who providecare and primar resuscitation'

K/0 1"DS2Advanced Trauma Life Support(ATLS) Trauma

3asualt Trauma ortalit BCrom the &epartment of Deneral Sur$er Al./ind Teachin$ ospital Ea$dad ra@

%.mailF red!awadGhotmail'com redhaH#adhimGahoo'com '

34T"D5CT34

Advanced Trauma Life Support (ATLS) was developed in the UnitedStates in the 1970s to provide a standardized method for the initialassessment and treatment of severel in!ured victims " phsicianswor#in$ in %mer$enc &epartments ( %&s)' The concept "ased onthe principles treat *rst what #ills *rst+ and do no further harm+

was initiall meant for doctors who are not alread e,perienced withcare of ma!or trauma victims1.2'

ATLS courses sponsored " the American 3olle$e of Sur$eons 3ommitteeon Trauma (A3S3?T)were held in Al./ind Teachin$ ospital a "i$$eneral hospital in Ea$hdad ra@' These courses were presented("oth lectures s#ill stations) " a well trained doctors (trainers oftrainee T?T) '%ach course was attended (for a period of 2 wee#s) "specialist and !unior doctors of di-erent specialties' The medical andparamedical sta- of Al./ind Teachin$ ospital (/T) also attendedthe courses' After *nishin$ the course each attendant was $iven acerti*cate of attendance' The aim of the courses is to increase thecompetence the a"ilit of the attendant doctor to deal withemer$enc cases to decrease mor"idit mortalit " applin$principles of ATLS i'e' primar surve secondar surve de*nitivemana$ement'

,AT3/4TS ./THDS

This is a retrospective stud of (12997) trauma patients admittedto 3& in /T durin$ the ear 2004(pre.ATLS period) of (4294)trauma patients admitted to same 3& durin$ the ear 2010(post.ATLS period)' The patients were distri"uted over ; seasons of theear as shown in ta"le 1 ta"le 2'Season >o' of patients >o' of

deaths

: of

deathsCirst season ;;28 6 1'197

Second season 282 ;8 1'7;4

Third season 267 6; 1'864

Courth season 2842 ;6 1'62
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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Total 12997 194 1'62

Ta"le 1' Trauma patients admitted to 3& in /T> in the ear 2004 (pre.ATLS) distri"utedover seasons of the ear (nI 12997)'

Season >o' of patients >o' of

deaths

: of

deaths

Cirst season 180 ;2 2'677

Second season 2278 68 2';80

Third season 2;4 ;4 1'989

Courth season 196; ;6 2'0

Total 4294 191 2'02

Ta"le 2' Trauma patients admitted to 3& in /T in the ear 2010(post.ATLS) distri"uted over seasons of the ear (nI 4294)'

n ear 2004 (pre.ATLS period) total num"er of patients was

(12997)' There were 868 males (60'6:) 6261 females (;0';:)

114 children (9'1:) um"er of total deaths was 191

(2':) num"er of male deaths was 1;6(76'918:) num"er of

female deaths was ;0(20'9;2:) num"er of child deaths was

8('1;1:)' See ta"le.;'


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Total

no' of

Jatient

s

>o' of

males

(:)

>o' of

female

s

(:)

>o' of

childre

n

(:)

Total

no' of

deaths

(:)

>o' of

male

deaths

(:)

>o' of

female

deaths

(:)

>o' of

child

deaths

(:)

12997 868

(62'6

:)

6261

(;0';

:)

114

(9'1:)

194

(1'62

:)

100

(60'6

:)

40

(;0';

:)

14

(9'1:)

Ta"le. summar of the statistical values accordin$ to a$e se, inear 2004 (pre.ATLS) in /T' (>o' of patientsI12997)'

Total

no' of

Jatient

s

>o' of

males

(:)

>o' of

female

s

(:)

>o' of

childre

n

(:)

Total

no' of

deaths

(:)

>o' of

male

deaths

(:)

>o' of

female

deaths

(:)

>o' of

child

deaths

(:)4294 8299

(76'9

:)

174

(20'9

:)

281

('16

:)

191

(2'0

:)

1;6

(76'92

:)

;0

(20'9;

:)

8

('1;

:)Ta"le.; summar of the statistical values accordin$ to a$e se, inear 2010 (post.ATLS) in /T' (>o' of patientsI4294)'

Ta"le .6 summarizes compares mortalit in /T in ear 2004(pre.ATLS) ear 2010 (post.ATLS) accordin$ to a$e se, andshows p.value (p-value is si$ni*cant if50'06)

Kear 2004 Kear 2010J.alue

Total no' of

Jatients

12997 4294

Total no' of

deaths (:)

194 (1'62:) 191 (2'0:) 0'722

>o' of male

deaths (:)

100 (60'6:) 1;6 (76'92:) 0'00;

>o' of female

deaths (:)

40 (;0';:) ;0 (20'9;:) 0'0002

>o' of child

deaths (:)

14 (9'1:) 8 ('1;:) 0'01;


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Ta"le.6' ortalit p.value in /T in ear 2004 (pre.ATLS) ear2010 (post.ATLS) accordin$ to a$e se,'

"/S5LTS

There were no statisticall si$ni*cant di-erencesin total death

rate "etween pre.ATLS period (ear 2004) and post.ATLS period

(ear 2010)


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n /T when we compare total no' of deaths in pre.ATLS periodand post.ATLS period we didnOt *nd a statisticall si$ni*cantdi-erence (p-value=0'722)' This ma "e due to lar$er no' of traumapatients seen in 3& in ear 2004(nI12997) compared to no' ofpatients seen in ear 2010(nI4294)' Eut when we compare death

rates accordin$ to a$e se, there is a statisticall si$ni*cantdi-erence (if p.value5 0'06)' ale deaths in pre.ATLS period was100(60'6:) while it was 1;6(76'9:) in post.ATLS period (p-value=0'00;)'The lar$er no' of male deaths in ear 2010 ma "edue to more males seen in this ear (nI8299I76'9: of totalnum"er)' >o' of female death in pre.ATLS period was 40(;0';:)while it was ;0(20'9;:) in post.ATLS period (p-valueI0'0002)' 3hilddeath in pre.ATLS period was 14 (9'1:) and 8 ('1;:) in post.ATLSperiod (p-value=0'01;)'So total death in pre.ATLS period (ear 2004) was 194 (1'62: fromtotal no' 12997) compared to total death of 191 (2': from totalno' 4294) in post.ATLS period (ear 2010)'

These results are not similar to the results in some other studies1.6' Der &'P' an?lden et al in 200 found no statistical si$ni*cancein his stud "etween pre. and post.ATLS periods and this ma "edue to small no' of patients studied (8 patients were studied)1'estrup et al in 1947 studied 60 patients in pre.ATLS 71 patientsin post.ATLS periods and the found no di-erence in mortalit afterATLS trainin$' Similar to our stud results were found " Ali et al(199)in a retrospective stud over a 9.ear period' Ali et al'demonstrated that the ATLS pro$ram si$ni*cantl improved trauma

outcome in a developin$ countr'Jost.ATLS trauma mortalitdecreased from 84: to ;: 6' ore studies are needed to evaluate the impact of applin$ ATLSprinciples' These studies should consider other parameters such ascauses of trauma causes and time of mortalit mortalit in 1sthourafter trauma (the $olden hour) and the people who provide theimmediate care and resuscitation in 3&s'

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?ur stud demonstrates that introduction of the ATLS pro$ram

si$ni*cantl improvedthe outcome and decrease mortalit intrauma patient admitted to 3&s in ra@i hospitals' t also improvesthe performance of doctors wor#in$ in 3&s who provide care andprimar resuscitation' Eut our stud didnOt consider all parametersa-ectin$ patientOs outcome' Althou$h further studies on lar$er no' ofpatients multicentre studies are needed to evaluate the "ene*tsof ATLS pro$ram application we recommend that ATLS pro$ramsshould "e applied as part of casualt trainin$ for doctors who carefor trauma patients'

"/6/"/4C/S


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1' Der &'P' an ?lden & Jh&P' &i# eeuwis & Jh&u$o Q' Eolhuis& Jh& an Eo,ma & Jh& A>& R' Pan A' Doris & Jh&200;M Am P of%mer edF22(7)F 222.226'

2' American 3olle$e of Sur$eons Advanced Trauma Life Support for

&octors (ATLS) Students 3ourse anual 4th%dition 2004'' estrup PA Stormor#en A Qood F mpact of advanced trauma life support trainin$ on earl trauma mana$ement' Am P Sur$ 1944M166F70;.704;' ' Arianaa$am &3 >aransin$h ara! F The impact of the ATLS course on trac accident mortalit in Trinidad and To"a$o' Qest ndies ed P 1992M;1F72.766' ' Ali PA Adam R Eutler A/ et alF Trauma outcome improves followin$ the advanced trauma life support pro$ramin a developin$ countr' P Trauma 199M;F490.49;8' ' 3hampion R Sacco QP 3opes QS et alF A revision of the trauma score' P Trauma 1949M29F82.8297' Ea#er SJ et alF The n!ur Severit ScoreF A method for descri"in$ patients with multiple in!uries and evaluatin$ emer$enc care' P Trauma 197;M1;F147.984' ' Eod 3& Tolson A 3opes QSF %valuatin$ trauma careF the TRSS method' P Trauma 1947M27F70.747 The American College of Surgeons2 4ational Trauma Data %an' "eport 899: Availa*le at http2;;$$$facsorg;trauma;ntd* html

The Application of Advanced Trauma Life Support

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