Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

Vinjevoll, Ole-Petter; Uleberg, Oddvar; Cole, Elaine

doi:10.1186/s13049-018-0533-y

Cited by 14 publications

(11 citation statements)

References 28 publications

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“…In the ISS ≥ 16 group more than 75% of patients either presented with abnormal vital functions or required lifesaving interventions. This appears to contrast with several other studies where patients with an ISS ≥ 16 did require emergency surgical interventions in only 20-31%, chest tube insertion in 22% and transfusion in 10% of patients [13,14]. However, these studies focused on the prevalence of single interventions, which were in a similar range as in our ISS ≥ 16 patients, but not at the total number of patients who required any of these procedures.…”

Section: Discussioncontrasting

confidence: 97%

“…However, these studies focused on the prevalence of single interventions, which were in a similar range as in our ISS ≥ 16 patients, but not at the total number of patients who required any of these procedures. Our prevalence of patients with abnormal vital signs (58.2%) compares well with the 52% observed in other studies [13].…”

Section: Discussionsupporting

confidence: 90%

“…To measure the quality of trauma team activation some post hoc definition is necessary to define, whether the activation of a trauma team was correct or not. Many researchers and quality controllers use the Injury Severity Score (ISS) alone, to differentiate between patients who require a trauma team (ISS ≥ 16) or not (ISS < 16) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. ISS is fairly easy to calculate, can be automatically retrieved from electronic records and it appears self-evident that a higher injury severity correlates with worse outcome and that more severely injured patients may benefit from a specialized trauma team.…”

Section: Introductionmentioning

confidence: 99%

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ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement

Waydhas

Bieler

Hamsen

et al. 2020

Eur J Trauma Emerg Surg

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Purpose An injury severity score (ISS) ≥ 16 alone, is commonly used post hoc to define the correct activation of a trauma team. However, abnormal vital functions and the requirement of life-saving procedures may also have a role in defining trauma team requirement post hoc. The aim of this study was to describe their prevalence and mortality in severely injured patients and to estimate their potential additional value in the definition of trauma team requirement as compared to the definition based on ISS alone. Methods Retrospective analysis of a trauma registry including patients with trauma team activation from the years 2009 until 2015, who were 16 years of age or older and were brought to the trauma center directly from the scene. Patients were divided into a group with an ISS ≥ 16 vs. ISS < 16. For analysis a predefined list of abnormal vital functions and life-saving interventions was used. Results 58,723 patients were included in the study (N = 32,653 with ISS ≥ 16; N = 26,070 with ISS < 16). From the total number of patients that required life-saving procedures or presented with abnormal vital functions 29.1% were found in the ISS < 16 group. From the ISS < 16 group, 36.7% of patients required life-saving procedures or presented with abnormal vital signs. The mortality of those was 8.1%. Conclusions Defining the true requirement of trauma team activation post hoc by using ISS ≥ 16 alone does miss a considerable number of subjects who require life-saving interventions or present with abnormal vital functions. Therefore, life-saving interventions and abnormal vital functions should be included in the definitions for trauma team requirement. Further studies have to evaluate, which life-saving procedures and abnormal vital functions are most relevant.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement

Waydhas

Bieler

Hamsen

et al. 2020

Eur J Trauma Emerg Surg

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“…Throughout many years the ability of field triage criteria to identify precisely severely injured patients have been addressed [2]. The results of this survey show that currently the national trauma system is not equipped to obtain important data on an important and specific quality indicator.…”

Section: Main Textmentioning

confidence: 99%

“…Suspicion that a person is seriously injured is based on all available knowledge -but due to the need of rapid transportation and treatment, the decision to consider the patient as seriously injured is often based on limited information. Patients who are severely injured (Injury Severity Score [ISS] greater than 15) and not received by a trauma team are commonly referred to as undertriaged (false-negatives) [2,3]. Failure to detect severe injury may cause delayed diagnosis and therapeutic interventions and is associated with increased morbidity [4,5].…”

Section: Introductionmentioning

confidence: 99%

Undertriage in trauma: an ignored quality indicator?

Jeppesen

Cuevas-Østrem

Gram-Knutsen

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Early identification of life-threatening injuries is essential to reduce morbidity and mortality in trauma patients. Failure to detect severe injury may cause delayed diagnosis and therapeutic interventions and is associated with increased morbidity. A national trauma system will contribute to ensure the optimal care for seriously injured patients throughout the treatment chain by, among other things, defining a sensitive triage tool for identifying severe injury and contribute to correct treatment destination. In 2017, a National trauma plan was implemented in Norway and several quality indicators were recommended to ensure an evaluation of potential gaps between achieved and desired quality, and thereby highlighting areas with potential for quality improvement. With this commentary, we want to draw attention to, what we believe is, an ignoring of an important quality indicator: undertriage in trauma. Main body: Severely injured patients not met by a trauma team is commonly referred to as undertriage. An undertriage rate below 5 % is an internationally recognized quality indicator in trauma care and is emphasized in the Norwegian national trauma plan. However, whether hospitals measure and report data about undertriage, have received little attention. Therefore, a national survey was performed among Norwegian hospitals, where thirty-seven of forty trauma receiving hospitals contributed. The results of the survey showed that only half of Norwegian trauma hospitals were capable of providing these data. The results of this survey show that currently the national trauma system is not equipped to obtain important data on an important and specific quality indicator. An ongoing discussion at a national level is how to define severe injury, which may alter future definitions on undertriage. Conclusions: Knowledge of undertriage in trauma is important to enhance patient safety, increase the precision of the triage tool and provide valuable learning information to individual hospitals and prehospital services. Currently only half of Norwegian hospitals who receive trauma patients report undertriage rates and unfortunately, only few hospital administrators request these data.

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Isolated vehicle rollover is not an independent predictor of trauma injury severity

et al. 2021

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Objectives The objective of this study was to determine if vehicle rollover in a motor vehicle crash is an independent predictor of major injury. Methods A retrospective cohort study of all patients injured in motor vehicle crashes presenting to a major trauma center between July 2012 and June 2016 was conducted. Crashes were classified into groups: non‐rollover, isolated rollover (without other mechanisms of injury), or mixed‐mechanism rollover (with other mechanisms of injury). Associations between rollover group, other covariates (entrapment, encapsulation, ejection, death on scene, high speed, seat belt usage, airbag deployment, trauma team activation), and major injury (injury severity score >15, major surgery, intensive care unit admission, or in‐hospital death) were tested using binary logistic regression models. Vehicle rollover was categorized either as “present” or “absent” on 1 model or as either “none,” “isolated,” or “mixed mechanism” in the other. Results In 2446 motor vehicle crashes, there were 423 rollovers (196 isolated, 227 mixed mechanisms). Compared with crashes without rollovers, the prevalence of patients with major injury was lower in crashes with isolated rollovers and higher in crashes with mixed‐mechanism rollovers (13.8% vs 9.5% vs 27.5%, respectively; P < 0.001). Rollover (present vs absent) was not an independent predictor of major injury (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.78–1.53). Patients in crashes with mixed‐mechanism but not isolated rollovers had increased odds (OR, 2.04; 95% CI, 1.41–2.96) of major injury compared with patients from crashes without rollovers. Conclusions Patients from crashes with isolated vehicle rollovers may not need to be transported to a trauma center as they carry a lower risk of injury.

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Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

Cited by 14 publications

References 28 publications

ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement

ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement

Undertriage in trauma: an ignored quality indicator?

Isolated vehicle rollover is not an independent predictor of trauma injury severity

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