• Mark Fitzgerald, Peter Cameron, Colin Mackenzie, Nathan Farrow, Pamela Scicluna, Robert Gocentas, Adam Bystrzycki, Geraldine Lee, Gerard O'Reilly, Nick Andrianopoulos, Linas Dziukas, D Jamie Cooper, Andrew Silvers, Alfredo Mori, Angela Murray, Susan Smith, Yan Xiao, Dion Stub, Frank T McDermott, and Jeffrey V Rosenfeld.
• Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia. m.fitzgerald@alfred.org.au
• Arch Surg. 2011 Feb 1;146(2):218-25.

HypothesisThis project tested the hypothesis that computer-aided decision support during the first 30 minutes of trauma resuscitation reduces management errors.DesignOurs was a prospective, open, randomized, controlled interventional study that evaluated the effect of real-time, computer-prompted, evidence-based decision and action algorithms on error occurrence during initial resuscitation between January 24, 2006, and February 25, 2008.SettingA level I adult trauma center.PatientsSeverely injured adults.Main Outcome MeasuresThe primary outcome variable was the error rate per patient treated as demonstrated by deviation from trauma care algorithms. Computer-assisted video audit was used to assess adherence to the algorithms.ResultsA total of 1171 patients were recruited into 3 groups: 300 into a baseline control group, 436 into a concurrent control group, and 435 into the study group. There was a reduction in error rate per patient from the baseline control group to the study group (2.53 to 2.13, P = .004) and from the control group to the study group (2.30 to 2.13, P = .04). The difference in error rate per patient from the baseline control group to the concurrent control group was not statistically different (2.53 to 2.30, P = .21). A critical decision was required every 72 seconds, and error-free resuscitations were increased from 16.0% to 21.8% (P = .049) during the first 30 minutes of resuscitation. Morbidity from shock management (P = .03), blood use (P < .001), and aspiration pneumonia (P = .046) were decreased.ConclusionsComputer-aided, real-time decision support resulted in improved protocol compliance and reduced errors and morbidity. Trial Registration clinicaltrials.gov Identifier: NCT00164034.

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