STRAUMA Code: The Systematic Approach to Simultaneous Stroke and Trauma Assessment - Strengthening the "Stroke-Trauma" Chain of Survival.

Introduction: In clinical practice, it is common to see stroke and trauma simultaneously in the same patient. When such a patient presents to the emergency department (ED), rapid assessment must be done to adequately manage both conditions. As the assessment will cover a significant number of steps and tasks to be accomplished, it may prove challenging, especially for a novice practitioner. As a result, key diagnostic signs may be missed or overlooked. This may cause nondiagnosis, misdiagnosis, or delay in the handling of time-dependent diagnoses (e.g. thrombolytic therapy decision for stroke and recognition of early shock in trauma). Therefore, the need for a comprehensive approach to the management of the patient who has simultaneous acute stroke and trauma is needed. Methods: We propose the Stroke-Trauma (STRAUMA) Code framework for use in the ED and by first-line healthcare staff. We used a trans-continental approach by testing our proposed STRAUMA framework at two centers: in the Department of Emergency Medicine at Singapore General Hospital in Singapore and in the Emergency Care Center at Sarasota Memorial Hospital in Sarasota, Florida, USA. Results: Both teams agreed that the new proposed STRAUMA Code framework is systematic, structured, and organized thus making it easier to apply in the clinical setting. Conclusion: A structured approach to manage the more complex cases presenting to the ED is useful so as not to miss important and often critical information and steps which will affect patient management as well as outcomes.