Changing from a two-tiered to a one-tiered trauma team activation protocol: a before–after observational cohort study investigating the clinical impact of undertriage

Thorsen, Kenneth; Narvestad, Jon Kristian; Tjosevik, Kjell E; Larsen, Johannes Wiik; Søreide, Kjetil

doi:10.1007/s00068-021-01696-y

Cited by 11 publications

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Wiles et al reported a small increase in the geriatric mortality rate following the implementation of a third tier, which is explained by the three patients with ISS >25 they cared for. 6,7 Finally, and perhaps most strikingly, Thorsen et al 10 found that the overall mortality rate significantly increased at their institution from 2.5% to 4.7% following the conversion of their trauma activation system from two levels to one level. Our data demonstrated no change in mortality rate, with a pre-GA mortality rate of 3.9% vs 3.4% post-GA. Our data did not demonstrate a mortality change in the matched cohort, but did show a benefit when looking at the geriatric subgroup.…”

Section: Discussionmentioning

confidence: 96%

Outcomes of Injured Patients Before and After the Institution of a Third-Tier Activation at a Level 1 Trauma Center

Young,

Young

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

Background We hypothesized that the addition of a third-level trauma activation would improve outcomes by formalizing an evaluation process for patients in need of urgent evaluation who did not meet the criteria for full or partial trauma alert activation. Methods Admission records for all trauma patients admitted between 2000 and 2021 were obtained. The gamma alert trauma activation was implemented in 2011. A washout period of 6 months was used to account for adjustment to the new protocol. Propensity score matching was performed based on ISS scores, age, injury mechanism, and best-validated comorbidities to create a balanced patient distribution. Patients with missing data were excluded from this study. The association between era and outcomes was determined using logistic and linear regression analyses. Results The matched cohort was well balanced (SMD <.1, all balanced covariates) and included 18,572 patients. Patients in the gamma alert era had decreased ED dwell time, hospital length of stay, and intensive care unit (ICU) length of stay. Readmission rates and rates of upgrade to ICU status were reduced in the gamma alert era. This era was also associated with lower rates of renal failure, UTI, and pneumonia. There was no significant difference in mortality following implementation of the gamma alert. Discussion Implementation of the gamma alert was associated with an improvement in ED dwell times, fewer unplanned admissions to the ICU, decreased readmissions, and a reduction in other in-hospital events. We believe that this reflects improved triage of patients to the ICU and more effective care of trauma patients.

show abstract

Section: Discussionmentioning

confidence: 96%

Outcomes of Injured Patients Before and After the Institution of a Third-Tier Activation at a Level 1 Trauma Center

Young,

Young

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

show abstract

“…A two-tiered TTA protocol was also shown to be associated with reduced undertriage, but increased overtriage [12]. On the other hand, a shift to a one-tier system showed increased undertriage and overall mortality, emphasizing the importance of carefully considering TTA protocol changes to avoid compromising patient care [13]. Additionally, studies conducted in trauma centers have implemented changes to TTA protocols to improve accuracy and resource utilization.…”

Section: Discussionmentioning

confidence: 99%

Time Delay in Motor Vehicle Accident Arrival: A Critical Analysis of Trauma Team Activation

Taylor,

McCague

2024

Cureus

View full text Add to dashboard Cite

IntroductionThis research aims to investigate the role of time since trauma (TST) in refining trauma team activation (TTA) criteria within a level I trauma center. We analyze the association between TST and post-emergency department (ED) disposition, proposing new insights for the enhancement of TTA criteria. MethodsA retrospective analysis was conducted on a dataset comprising 3,693 patients presenting to a level I trauma center following motor vehicle accidents (MVAs) from 2016 to 2021. Data from a trauma registry, encompassing time of injury, time of ED arrival, TTA status, and post-ED disposition, were utilized. TST was calculated as the difference between the time of injury and the time of ED arrival. Patients that received TTA, full or partial, were categorized based on TST (less than one hour, one to two hours, and two or more hours). Statistical analyses, including chi-square tests, were performed using the Statistical Analysis System (SAS) (version 3.8, SAS Institute Inc., Cary, NC). ResultsOf the 1,261 patients meeting the criteria, 98.3% received TTA, with decreasing TTA rates observed with increasing TST (p = 0.0076). A significant association was found between TST and post-ED disposition for patients who received TTA (p = 0.0007). Compared to the other TST groups, a higher proportion of patients with a TST of two or more hours were admitted, sent to the intensive care unit (ICU), and sent to the operating room (OR). ConclusionThe study indicates a statistically significant relationship between TST and TTA rates, challenging our assumptions about the decreased need for TTA over time. While a longer TST was associated with a lower percentage of TTA, patients with a TST of two or more hours demonstrated increased rates of admission, ICU utilization, and surgical interventions. This suggests that TTA criteria may benefit from refinement to include patients with longer TST. Acknowledging study limitations, such as a small sample size and retrospective design, this research contributes valuable insights into potential considerations for optimizing trauma care protocols.

show abstract

“…A large meta-analysis reported a fatality rate of 65% for severe TBI patients over 60 years of age [33]. Elderly trauma patients are at greater risk of under-triage and most under-triage deaths are secondary to TBI [34][35][36]. Undertriage has been reported for elderly patients, who are less often triaged with the highest priority level.…”

Section: Mortality and Outcomementioning

confidence: 99%

Incidence, Mechanisms of Injury and Mortality of Severe Traumatic Brain Injury: An Observational Population‐Based Cohort Study from New Zealand and Norway

Weber

Andreassen

Isles³

et al. 2022

World j. surg.

Self Cite

View full text Add to dashboard Cite

Background Comparing trauma registry data from different countries can help to identify possible differences in epidemiology, which may help to improve the care of trauma patients. Methods This study directly compares the incidence, mechanisms of injuries and mortality of severe TBI based on population-based data from the two national trauma registries from New Zealand and Norway. All patients prospectively registered with severe TBI in either of the national registries for the 4-year study period were included. Patient and injury variables were described and age-adjusted incidence and mortality rates were calculated. Results A total of 1378 trauma patients were identified of whom 751 (54.5%) from New Zealand and 627 (45.5%) from Norway. The patient cohort from New Zealand was significantly younger (median 32 versus 53 years; p < 0.001) and more patients from New Zealand were injured in road traffic crashes (37% versus 13%; p < 0.001). The age-adjusted incidence rate of severe TBI was 3.8 per 100,000 in New Zealand and 2.9 per 100,000 in Norway. The age-adjusted mortality rates were 1.5 per 100,000 in New Zealand and 1.2 per 100,000 in Norway. The fatality rates were 38.5% in New Zealand and 34.2% in Norway (p = 0.112). Conclusions Road traffic crashes in younger patients were more common in New Zealand whereas falls in elderly patients were the main cause for severe TBI in Norway. The age-adjusted incidence and mortality rates of severe TBI among trauma patients are similar in New Zealand and Norway. The fatality rates of severe TBI are still considerable with more than one third of patients dying.

show abstract

Changing from a two-tiered to a one-tiered trauma team activation protocol: a before–after observational cohort study investigating the clinical impact of undertriage

Cited by 11 publications

References 14 publications

Outcomes of Injured Patients Before and After the Institution of a Third-Tier Activation at a Level 1 Trauma Center

Outcomes of Injured Patients Before and After the Institution of a Third-Tier Activation at a Level 1 Trauma Center

Time Delay in Motor Vehicle Accident Arrival: A Critical Analysis of Trauma Team Activation

Incidence, Mechanisms of Injury and Mortality of Severe Traumatic Brain Injury: An Observational Population‐Based Cohort Study from New Zealand and Norway

Contact Info

Product

Resources

About