Evaluation of a standardized instrument for post hoc analysis of trauma-team-activation-criteria in 75,613 injured patients an analysis of the TraumaRegister DGU®

Abstract

Introduction To improve the quality of criteria for trauma-team-activation it is necessary to identify patients who benefited from the treatment by a trauma team. Therefore, we evaluated a post hoc criteria catalogue for trauma-team-activation which was developed in a consensus process by an expert group and published recently. The objective was to examine whether the catalogue can identify patients that died after admission to the hospital and therefore can benefit from a specialized trauma team mostly. Materials and methods The catalogue was applied to the data of 75,613 patients from the TraumaRegister DGU® between the 01/2007 and 12/2016 with a maximum abbreviated injury score (AIS) severity ≥ 2. The endpoint was hospital mortality, which was defined as death before discharge from acute care. Results The TraumaRegister DGU® dataset contains 18 of the 20 proposed criteria within the catalogue which identified 99.6% of the patients who were admitted to the trauma room following an accident and who died during their hospital stay. Moreover, our analysis showed that at least one criterion was fulfilled in 59,785 cases (79.1%). The average ISS in this group was 21.2 points (SD 9.9). None of the examined criteria applied to 15,828 cases (average ISS 8.6; SD 5). The number of consensus-based criteria correlated with the severity of injury and mortality. Of all deceased patients (8,451), only 31 (0.37%) could not be identified on the basis of the 18 examined criteria. Where only one criterion was fulfilled, mortality was 1.7%; with 2 or more criteria, mortality was at least 4.6%. Discussion The consensus-based criteria identified nearly all patients who died as a result of their injuries. If only one criterion was fulfilled, mortality was relatively low. However, it increased to almost 5% if two criteria were fulfilled. Further studies are necessary to analyse and examine the relative weighting of the various criteria. Summary Our instrument is capable to identify severely injured patients with increased in-hospital mortality and injury severity. However, a minimum of two criteria needs to be fulfilled. Based on these findings, we conclude that the criteria list is useful for post hoc analysis of the quality of field triage in patients with severe injury.

Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers

“…If the criteria for the appropriateness of trauma team activation [ 11 , 12 ] were used ( n = 764) as the gold standard to define which patients need a TTA ( Table 5 ), TTA only occurred in 490 cases (64.1%); thus, the proportion of patients without TTA was 35.9% ( n = 274), and therefore the undertriage rate was much higher. Patients who were undertriaged according to the appropriateness of TTA criteria were considerably older (median 74 versus 54 years) but were less seriously injured (median ISS 4 versus 13).…”

“…However, not every patient with ISS 16+ might need the full trauma team, while several patients with an ISS below 16 might benefit from a TTA [ 10 ]. Therefore, in recent years, other criteria, which are sometimes subsumed under the term “need for trauma intervention”, have gained wider acceptance [ 7 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] and have been shown to be superior to the classification based on injury severity alone [ 10 , 13 , 17 , 18 ]. Examples of these criteria include the transfusion of red blood cells, mechanical ventilation, admission to ICU, or need for interventional radiology [ 13 ].…”

Whole-Body Magnetic Resonance Tomography and Whole-Body Computed Tomography in Pediatric Polytrauma Diagnostics—A Retrospective Long-Term Two-Center Study

“…It remains difficult to choose the appropriate imaging modality based on conjecture, external physical signs, putative instability, and concomitant factors, such as the trauma mechanism. The detection of severely injured patients and adjustment of the needed resources for treatment is still an interesting issue of ongoing research in adults, but, of course, also in pediatric patients [ 36 , 37 ]. There is no evidence for using WBMR in the case of polytraumatized children with unstable circulation, in our opinion.…”

Schockraumzuweisung

“…Eine Expertengruppe um Bieler et al [38] analysierte, welche Kriterien in einer Post-hoc-Analyse die Schockraumaktivierung notwendig erscheinen lassen (s. Übersicht). Diese Analyse ist sehr viel dezidierter und beschränkt sich nicht ausschließlich auf den ISS.…”