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Introduction: The Amsterdam Trauma Workflow (ATW) concept includes a sliding gantry CT scanner serving two mirrored (trauma) rooms. In this study, several predefined scenarios with a varying number of CT scanners and CT locations are analyzed to identify the best performing patient flow management strategy from an institutional perspective on process quality., Materials and Methods: A total of six clinically relevant scenarios with variables that included the number of CT scanners, CT scanner location, and different patient categories (regular, urgent, and trauma patients) were evaluated using computer simulation. Each scenario was simulated using institutional data and was assessed for patient waiting times, idle time of CT scanners, and overtime due to scheduling. The best 2- and 3-scanner scenarios were additionally evaluated with the ATW-concept., Results: Based on institutional data, the best 2-scanner scenario distributes all 3 patient categories over both scanners and plans 4 urgent patients per hour while locating both scanners outside of the trauma room. The best 3-scanner scenario distributes urgent and regular patients over all 3 scanners and trauma patients on only 1 scanner and locates all CT scanners outside of the trauma room. The ATW concept reduces waiting times and overtime, while increasing idle time., Conclusion: Choosing the optimal planning and distribution strategies depends on the number and location of available CT scanners, along with number of trauma, urgent and regular patients. The Amsterdam Trauma Workflow concept could provide institutions with the ability of early CT scanning in trauma patients without influencing regular and urgent CT scanning., (Copyright © 2010. Published by Elsevier Ireland Ltd.)

Introduction: While computed tomography (CT) scan usage in acute trauma patients is currently part of the standard complete diagnostic workup, little is known regarding the time factors involved when CT scanning is added to the standard workup. An analysis of the current time factors and intervals in a high-volume, streamlined level-1 trauma center can potentially expose points of improvement in the trauma resuscitation phase., Materials and Methods: During a 5-week period, data on current time factors involved in CT scanned trauma patients were prospectively collected. All consecutive trauma patients seen in the Emergency Department following severe trauma, or inter-hospital transfer following initial stabilizing elsewhere, and that underwent CT scanning, were included. Patients younger than 16 years of age were excluded. For all eligible patients, a complete time registration was performed, including admission time, time until completion of trauma series, time until CT imaging, and completion of CT imaging. Subgroup analyses were performed to differentiate severity of injury, based on ISS, and on primary or transfer presentations, surgery, and ICU admittance., Results: Median time between the arrival of the patient and completion of the screening X-ray trauma series was 9 min. Median start time for the first CT scan was 82 min. The first CT session was completed in a median of 105 min after arrival. Complete radiological workup was finished in 114 min (median). In 62% of all patients requiring CT scanning, a full body CT scan was obtained. Patients with ISS >15 had a significant shorter time until CT imaging and time until completion of CT imaging., Conclusion: In a high-volume level-1 trauma center, the complete radiological workup of trauma patients stable enough to undergo CT scanning, is completed in a median of 114 min. Patients that are more severely injured based on ISS were transported faster to CT, resulting in faster diagnostic imaging.

Patients with a (potential) cervical spine injury can be subdivided into low-risk and high-risk patients. With a detailed history and physical examination the cervical spine of patients in the "low-risk" group can be "cleared" without further radiographic examinations. X-ray imaging (3-view series) is currently the primary choice of imaging for patients in the "low-risk" group with a suspected cervical spine injury after blunt trauma. For patients in the "high-risk"group because of its higher sensitivity a computed tomography scan is primarily advised or, alternatively, the cervical spine is immobilised until the patient can be reliably questioned and examined again. For the imaging of traumatic soft tissue injuries of the cervical spine magnetic resonance imaging is the technique of choice.

Background: To reduce overtriage of trauma patients while at the same time minimising undertriage, an in-hospital triage tool was developed with the purpose of reducing the initial full trauma team (downgrading) in a structured and evidence-based manner. This study evaluated the effect on overtriage rates by the AMC downgrading protocol (AMCDP) consisting of 24 criteria scored during the primary survey., Patients and Methods: We prospectively investigated if any of the patients treated by the downgraded trauma team (DTT) were undertriaged by the protocol. All patients fulfilling the definition of severely injured (SI) patients but treated by the DTT were deemed undertriaged patients. Overtriage was measured by the percentage of patients treated by a full trauma team (FTT) while not classified as an SI patient., Results: A total of 220 patients were eligible and triaged by the AMCDP. After triage, 95 patients (43%) were treated by the DTT while 125 patients (57%) were treated by the FTT. A total of 66 patients (30%) met one or more of the criteria for an SI patient. None of these patients were treated by the DTT. Of the 125 patients treated by the FTT, 59 patients were not defined as SI., Conclusion: For the entire study population no undertriage was found, while implementation of the AMCDP reduced overtriage in the entire study population from 70% to 26.8%. Similar trauma centres can benefit from implementing the AMC downgrading protocol.