PMID- 36600301
OWN - NLM
STAT- MEDLINE
DCOM- 20230106
LR  - 20230217
IS  - 1749-7922 (Electronic)
IS  - 1749-7922 (Linking)
VI  - 18
IP  - 1
DP  - 2023 Jan 4
TI  - Structured approach with primary and secondary survey for major trauma care: an 
      overview of reviews.
PG  - 2
LID - 10.1186/s13017-022-00472-6 [doi]
LID - 2
AB  - BACKGROUND: A structured approach involves systematic management of trauma 
      patients. We aim to conduct an overview of reviews about the clinical efficacy 
      and safety of structured approach (i.e., primary and secondary survey) by 
      guideline checklist compared to non-structured approach (i.e. clinical 
      examination); moreover, routine screening whole-body computer tomography (WBCT) 
      was compared to non-routine WBCT in patients with suspected major trauma. 
      METHODS: We systematically searched MEDLINE (PubMed), EMBASE and Cochrane 
      Database of Systematic Reviews up to 3 May 2022. Systematic reviews (SRs) that 
      investigated the use of a structured approach compared to a non-structured 
      approach were eligible. Two authors independently extracted data, managed the 
      overlapping of primary studies belonging to the included SRs and calculated the 
      corrected covered area (CCA). The certainty of evidence was assessed using the 
      Grading of Recommendations Assessment, Development and Evaluation (GRADE) 
      methodology. RESULTS: We included nine SRs investigating two comparisons in 
      stable trauma patients: structured approach vs non-structured approach (n = 1) 
      and routine WBCT vs non-routine WBCT (n = 8). The overlap of included primary 
      studies was generally high across outcomes (CCA ranged between 20.85 and 42.86%) 
      with some discrepancies in the directions of effects across reviews. The 
      application of a structured approach by checklist may improve adherence to 
      guidelines (e.g. Advanced Trauma Life Support) during resuscitation and might 
      lead to a reduction in mortality among severely injured patients as compared to 
      clinical examination (Adjusted OR 0.51; 95% CI 0.30-0.89; p = 0.018; low 
      certainty of evidence). The use of routine WBCT seems to offer little to no 
      effects in reducing mortality and time spent in emergency room or department, 
      whereas non-routine WBCT seems to offer little to no effects in reducing 
      radiation dose, intensive care unit length of stay (LOS) and hospital LOS 
      (low-to-moderate certainty of evidence). CONCLUSIONS: The application of 
      structured approach by checklist during trauma resuscitation may improve patient- 
      and process-related outcomes. Including non-routine WBCT seems to offer the best 
      trade-offs between benefits and harm. Clinicians should consider these findings 
      in the light of their clinical context, the volume of patients in their 
      facilities, the need for time management, and costs.
CI  - (c) 2023. The Author(s).
FAU - Gianola, Silvia
AU  - Gianola S
AD  - Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. 
      silvia.gianola@grupposandonato.it.
FAU - Bargeri, Silvia
AU  - Bargeri S
AD  - Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
FAU - Biffi, Annalisa
AU  - Biffi A
AD  - National Centre for Healthcare Research and Pharmacoepidemiology,, University of 
      Milano-Bicocca, Milan, Italy.
AD  - Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics 
      and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
FAU - Cimbanassi, Stefania
AU  - Cimbanassi S
AD  - General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, 
      University of Milan, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
FAU - D'Angelo, Daniela
AU  - D'Angelo D
AD  - Centro Nazionale per l Eccellenza Clinica, laQualita e la Sicurezza delle Cure, 
      Istituto Superiore di Sanita, Rome, Italy.
FAU - Coclite, Daniela
AU  - Coclite D
AD  - Centro Nazionale per l Eccellenza Clinica, laQualita e la Sicurezza delle Cure, 
      Istituto Superiore di Sanita, Rome, Italy.
FAU - Facchinetti, Gabriella
AU  - Facchinetti G
AD  - Centro Nazionale per l Eccellenza Clinica, laQualita e la Sicurezza delle Cure, 
      Istituto Superiore di Sanita, Rome, Italy.
FAU - Fauci, Alice Josephine
AU  - Fauci AJ
AD  - Centro Nazionale per l Eccellenza Clinica, laQualita e la Sicurezza delle Cure, 
      Istituto Superiore di Sanita, Rome, Italy.
FAU - Ferrara, Carla
AU  - Ferrara C
AD  - Centro Nazionale per l Eccellenza Clinica, laQualita e la Sicurezza delle Cure, 
      Istituto Superiore di Sanita, Rome, Italy.
FAU - Di Nitto, Marco
AU  - Di Nitto M
AD  - Centro Nazionale per l Eccellenza Clinica, laQualita e la Sicurezza delle Cure, 
      Istituto Superiore di Sanita, Rome, Italy.
FAU - Napoletano, Antonello
AU  - Napoletano A
AD  - Centro Nazionale per l Eccellenza Clinica, laQualita e la Sicurezza delle Cure, 
      Istituto Superiore di Sanita, Rome, Italy.
FAU - Punzo, Ornella
AU  - Punzo O
AD  - Centro Nazionale per l Eccellenza Clinica, laQualita e la Sicurezza delle Cure, 
      Istituto Superiore di Sanita, Rome, Italy.
FAU - Ranzato, Katya
AU  - Ranzato K
AD  - Gruppo MultiMedica, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.
FAU - Tratsevich, Alina
AU  - Tratsevich A
AD  - National Centre for Healthcare Research and Pharmacoepidemiology,, University of 
      Milano-Bicocca, Milan, Italy.
AD  - Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics 
      and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
FAU - Iannone, Primiano
AU  - Iannone P
AD  - Dipartimento di Medicina Interna, Azienda USL, Ospedale Maggiore, Largo Nigrisoli 
      2, 40133, Bologna, Italy.
FAU - Castellini, Greta
AU  - Castellini G
AD  - Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
FAU - Chiara, Osvaldo
AU  - Chiara O
AD  - General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, 
      University of Milan, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
CN  - Italian National Institute of Health guideline working group on Major Trauma
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20230104
PL  - England
TA  - World J Emerg Surg
JT  - World journal of emergency surgery : WJES
JID - 101266603
SB  - IM
MH  - Humans
MH  - Systematic Reviews as Topic
MH  - *Emergency Service, Hospital
MH  - *Tomography, X-Ray Computed/methods
MH  - Length of Stay
MH  - Injury Severity Score
PMC - PMC9814503
OTO - NOTNLM
OT  - Advanced trauma life support care
OT  - Checklist
OT  - Diagnostic imaging
OT  - Emergency medicine
OT  - GRADE approach
OT  - Meta-analysis as topic
OT  - Structured approach
OT  - Systematic reviews
COIS- The authors declare that they have no competing interests.
EDAT- 2023/01/05 06:00
MHDA- 2023/01/07 06:00
PMCR- 2023/01/04
CRDT- 2023/01/04 23:38
PHST- 2022/11/09 00:00 [received]
PHST- 2022/12/25 00:00 [accepted]
PHST- 2023/01/04 23:38 [entrez]
PHST- 2023/01/05 06:00 [pubmed]
PHST- 2023/01/07 06:00 [medline]
PHST- 2023/01/04 00:00 [pmc-release]
AID - 10.1186/s13017-022-00472-6 [pii]
AID - 472 [pii]
AID - 10.1186/s13017-022-00472-6 [doi]
PST - epublish
SO  - World J Emerg Surg. 2023 Jan 4;18(1):2. doi: 10.1186/s13017-022-00472-6.