Original contributions
Clinical impact of advanced trauma life support

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Abstract

The Advanced Trauma Life Support (ATLS) course sponsored by the American College of Surgeons Committee On Trauma (ACSCOT) presents a standardized method of initial trauma care. This study attempted to measure any changes in morbidity and mortality in trauma patients after the introduction of ATLS training. Over a 3-year period (May 1996 to September 1997—pre-ATLS period; December 1997 to April 1999—post-ATLS period), 63 trauma patients with an Injury Severity Scale (ISS) ≥16 (n = 31, pre-ATLS and n = 32, post-ATLS) were prospectively studied in two community teaching hospitals. There was no significant difference in mortality rate between groups (48% [15 of 31] pre-ATLS vs. 30% [10 of 32] post-ATLS; P = .203, Fisher exact test). Mortality rates within the ISS range of 16 to 25 were 64% (nine of 14 pre-ATLS) versus 29% (five of 17 post-ATLS), and for the ISS 26 to 35 subgroup, 40% (four of 10 pre-ATLS) versus 25% (two of eight post-ATLS), and within the ISS 36 to 75 subgroup, 29% (two of seven pre-ATLS) versus 43% (three of seven post-ATLS). There was a significant difference in mortality during the first 60 minutes after admission: 0.0% post-ATLS versus 24.2% pre-ATLS (P = .002, Fisher exact test (95% confidence interval ranged from 12–45% in the pre-ATLS group and 0–11% in the post-ATLS group). According to the TRISS methodology (a worldwide-accepted mathematical method to calculate chances of survival through logistical regression),ATLS improved outcome from sub-“Major Trauma Outcome Study” (MTOS) standard results (z = −2.9 to a MTOS standard result z = −0.49). Our data demonstrate that introduction of the ATLS program significantly improved trauma patient outcome in the first hour after admission, as well as improvement from sub-MTOS standard to MTOS standard levels.

Section snippets

Materials and methods

We performed a prospective, sequential, cohort study, including a pre-, and a post-ATLS training period. Patients were entered in the study in two community residency training (ACS level III) hospitals. Both EDs have an annual patient census of 20,000 and treat approximately 25 severely traumatized victims per year. The patients in the study were treated by residents and general surgeons but not by residency trained EM physicians or trauma surgeons.

Prospective registration of all data were

Results

In the pre-ATLS period from June 1996 to November 1997, 31 patients were included in the study and in the post-ATLS period from January 1998 through July 1999, 32 patients entered.

We found no statistically significant differences in the patient characteristics between the two groups (Table 1). There was no significant difference in the etiologies of cases (Table 2). There was a significant difference in mortality between groups in the first 60 minutes after arrival (P = .002, Fisher exact

Discussion

The ATLS course emphasizes the primary management of the injured patient, starting at the time of injury and continuing through the initial assessment, life-saving interventions, reevaluation, stabilization and, when needed, transfer to a trauma center. This course is intended for all physicians who could be involved in acute trauma care. The question addressed in this study is whether ATLS training affects the fate of the trauma patient.

Introduction of the ATLS course in The Netherlands

Conclusion

Our data demonstrate that introduction of the ATLS program 1-hour outcomes significantly improved, but overall outcomes are not. According to the TRISS methodology ATLS improved outcome from a sub-MTOS standard results to MTOS standard result (z −2.09 vs. z −0.49)7.

References (7)

  • J.A. Vestrup et al.

    Impact of advanced trauma life support training on early trauma management

    Am J Surg

    (1988)
  • D.C. Ariyanayagam et al.

    The impact of the ATLS course on traffic accident mortality in Trinidad and Tobago

    West Indies Med J

    (1992)
  • J.A. Ali et al.

    Trauma outcome improves following the advanced trauma life support program in a developing country

    J Trauma

    (1993)
There are more references available in the full text version of this article.

Cited by (0)

This study was supported by the ATLS Foundation Netherlands, the Dutch Trauma Society, and the Department of Surgery University Hospital Nijmegen, The Netherlands.

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