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Errors in adult trauma resuscitation: a systematic review

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Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Introduction

Trauma resuscitation at dedicated trauma centers typically consist of ad-hoc teams performing critical tasks in a time-limited manner. This creates a high stakes environment apt or avoidable errors. Reporting of errors in trauma resuscitation is generally center-dependent and lacks common terminology.

Methods

We conducted a systematic review by searching Ovid Medline, Scopus and Embase from inception to February 24, 2021 for errors in adult trauma resuscitation. English studies published after 2001 were included. Studies were assessed by two independent reviewers for meeting inclusion/exclusion criteria. Errors were characterized from the included studies and a summary table was developed. Our review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020152875).

Results

The literature search retrieved 4658 articles with 26 meeting eligibility criteria. Errors were identified by morbidity and mortality rounds or other committee in 62%, missed injuries on tertiary assessment or radiology review in 12%, deviations from algorithmic guidelines in 12% or predefined for chest tube complications, critical incident reporting, aspiration or delays in care. In total there were 39 unique error types identified and divided into 9 categories including Emergency Medical Services handover, airway, assessment of injuries, patient monitoring and access, transfusion/blood related, management of injuries, team communication/dynamics, procedure error and disposition.

Conclusions

Overall, our systematic review identified 39 unique error types in trauma resuscitation. Identifying these errors is imperative in developing systems for improvement of trauma care.

Résumé

Introduction

La réanimation des traumatisés dans les centres de traumatologie spécialisés consiste généralement en des équipes ad hoc qui effectuent des tâches critiques dans un temps limité. Cela crée un environnement à enjeux élevés susceptible de provoquer des erreurs évitables. Le signalement des erreurs de réanimation traumatologique dépend généralement du centre et manque de terminologie commune

Méthodes

Nous avons effectué une revue systématique en recherchant dans Ovid Medline, Scopus et Embase, du début au 24 février 2021, des erreurs de réanimation traumatologique chez l'adulte. Les études anglaises publiées après 2001 ont été incluses. Deux examinateurs indépendants ont évalué les études pour déterminer si elles répondaient aux critères d’inclusion et d’exclusion. Les erreurs ont été caractérisées à partir des études incluses et un tableau récapitulatif a été élaboré. Notre étude a été enregistrée de manière prospective dans l'International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020152875).

Résultats

La recherche documentaire a permis d'extraire 4658 articles, dont 26 répondaient aux critères d'admissibilité. Les erreurs ont été identifiées par les rondes de morbidité et de mortalité ou par un autre comité dans 62% des cas, les blessures manquées lors de l'évaluation tertiaire ou de l'examen radiologique dans 12% des cas, les déviations par rapport aux directives algorithmiques dans 12% des cas ou prédéfinies pour les complications du tube thoracique, le signalement des incidents critiques, l'aspiration ou les retards dans les soins. Au total, 39 types d'erreurs uniques ont été identifiés et répartis en 9 catégories : transfert des services médicaux d'urgence, voies respiratoires, évaluation des blessures, surveillance et accès du patient, transfusion/sang, gestion des blessures, communication/dynamique de l'équipe, erreur de procédure et disposition.

Conclusions

Dans l'ensemble, notre étude systématique a identifié 39 types d'erreurs uniques dans la réanimation des traumatismes. L'identification de ces erreurs est impérative pour développer des systèmes d'amélioration des soins en traumatologie.

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Search strategy available in Appendix B.

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Acknowledgements

The authors would like to thank David Lightfoot, information specialist at St. Michael’s Hospital, for his assistance with the literature search and development of the search strategy.

Funding

There was no specific funding used for this study from any agency in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Emergency Medicine, Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen’s Park Crescent West, Third Floor, Room 304, Toronto, ON, M5S 3H2, Canada

    Anton Nikouline, Andrew Quirion & Brodie Nolan

  2. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    James J. Jung

  3. International Centre for Surgical Safety, St. Michael’s Hospital, Toronto, ON, Canada

    James J. Jung & Brodie Nolan

  4. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Brodie Nolan

  5. Department of Emergency Medicine, St. Michael’s Hospital, Toronto, ON, Canada

    Brodie Nolan

Authors
  1. Anton Nikouline
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  2. Andrew Quirion
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  3. James J. Jung
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  4. Brodie Nolan
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Contributions

AN participated in the literature search, data collection, data analysis, data interpretation, study design and writing of the manuscript, AQ participated in the data collection and data analysis. JJ participated in the study design, data interpretation and critical revision. BN participated in the study design, data analysis, data interpretation, writing and critical revision.

Corresponding author

Correspondence to Anton Nikouline.

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None declared.

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None required for systematic review.

Supplementary Information

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Supplementary file 1 (DOCX 33 kb)

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Nikouline, A., Quirion, A., Jung, J.J. et al. Errors in adult trauma resuscitation: a systematic review. Can J Emerg Med 23, 537–546 (2021). https://doi.org/10.1007/s43678-021-00118-7

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  • DOI: https://doi.org/10.1007/s43678-021-00118-7

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