Western Trauma Association Critical Decisions in Trauma

Walter L. Biffl, Ernest E. Moore, David V. Feliciano, Roxie A. Albrecht, Martin Croce, Riyad Karmy-Jones, Nicholas Namias, Susan Rowell, Martin Schreiber, David V. Shatz, Karen Brasel
2015 Journal of Trauma and Acute Care Surgery  
DISCLAIMER: The Western Trauma Association (WTA) develops algorithms to provide guidance and recommendations for particular practice areas, but does not establish the standard of care. The WTA algorithms are based on the evidence available in the literature and the expert opinion of the task force in the recent timeframe of the publication. The WTA considers use of the algorithm to be voluntary. The ultimate determination regarding its application is to be made by the treating physician and
more » ... g physician and health care professionals with full consideration of the individual patient's clinical status as well as available institutional resources; it is not intended to take the place of health care providers' judgment in diagnosing and treating particular patients. 3 This is a recommended management algorithm from the WTA addressing the diagnostic evaluation and management of esophageal injuries in adult patients. Because there are a paucity of published prospective randomized clinical trials that have generated class I data, the recommendations herein are based primarily on published observational studies and expert opinion of WTA members. The algorithms (Figures 1 and 2) and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers. We recognize that there will be patient, personnel, institutional, and situational factors that may warrant or require deviation from the recommended algorithm. We encourage institutions to use this guideline to formulate their own local protocols. The algorithm contains letters at decision points; the corresponding paragraphs in the text elaborate on the thought process and cite pertinent literature. The annotated algorithm is intended to a) serve as a quick bedside reference for clinicians; b) foster more detailed patient care protocols that will allow for prospective data collection and analysis to identify best practices; and c) generate research projects to answer specific questions concerning decision making in the management of adults with esophageal injuries.
doi:10.1097/ta.0000000000000772 pmid:26680145 fatcat:wr557kvewje75lpgktgr52vctu