Barriers to compliance with evidence-based care in trauma

• DOI: 10.1097/ta.0b013e318243da4d
• Publication Date: 2012-12-11T18:03:40Z
• Authors: Nadine Rayan; Sunni Barnes; Neil Fleming; Rustam Kudyakov; David Ballard; Larry M. Gentilello; Shahid Shafi
• Keywords: Trauma Center; Abbreviated Injury Scale

BACKGROUND: We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose this study was to identify least likely optimal care. METHODS: Records a random sample 774 admitted Level I center (2006–2008) with moderate severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance 25 trauma-specific processes (T-POC) endorsed Advanced Trauma Life Support, Eastern Association Surgery Trauma, Brain Foundation, Surgical Care Improvement Project, and Glue Grant Consortium based on evidence or consensus. These encompassed all aspects care, including initial evaluation, resuscitation, operative critical rehabilitation, injury prevention. Multivariate logistic regression used RESULTS: Study eligible total 2,603 T-POC, which only 1,515 (58%) provided patient. Compliance highest T-POC involving resuscitation (83%) lowest neurosurgical interventions (17%). Increasing severity head associated lower compliance, while intensive unit stay higher compliance. There no relationship between patient demographics, socioeconomic status, overall severity, daily volume admissions. CONCLUSION: Little over half delivered injuries. Patients increasing traumatic brain However, differences among subgroups are small in relation gap observed LEVEL OF EVIDENCE: II.