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Journal of Trauma and Injury 2012;25(4):159-165.
Application of Critical Pathway in Trauma Patients
Hongjin Shim, Ji Yong Jang, Jae Gil Lee, Seonghwan Kim, Min Joung Kim, You Seok Park, Inchel Park, Seung Ho Kim
1Department of Surgery, Yonsei University College of Medicine, Korea. jakii@yuhs.ac
2Department of Emergency Medicine, Yonsei University College of Medicine, Korea.
외상 환자 관리에서 Critical Pathway의 적용
심홍진∙장지영∙이재길∙김승환1∙김민정1∙박유석1∙박인철1∙김승호1
연세대학교 의과대학 세브란스병원 중환자관리 및 외상외과, 1응급의학과
Received: 14 September 2012   • Revised: 2 October 2012   • Accepted: 23 October 2012
Abstract
PURPOSE
For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients.
METHODS
The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed.
RESULTS
The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was 6.4+/-2.0. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively.
CONCLUSION
The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.
Key Words: Critical Pathway; Trauma


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