Evaluation of a trauma team activation protocol revision: a prospective cohort study

Abstract

BackgroundCorrect triage based on prehospital information contributes to a better outcome for potentially seriously injured patients. In 2011 we changed the trauma team activation (TTA) criteria in our center in order to improve the high over- and undertriage properties of the protocol. Five criteria that were unable to predict severe injury were removed. In the present study, we evaluated the protocol revision by comparing over- and undertriage in the former and present set of criteria.MethodsAll severely injured patients (Injury Severity Score (ISS) > 15) and all patients admitted with TTA in the period of 01.01.2013 – 31.12.2014 were included in the study. We defined overtriage as the fraction of patients with TTA when ISS ≤15 and undertriage as the fraction of patients without TTA when ISS > 15. We also evaluated triage with the occurrence of emergency procedures immediately after admission.Results324 patients were included, 164 patients had ISS>15, 287 were admitted with TTA. Over- and undertriage were 74 % and 28 % respectively. When we used emergency procedure as reference, the figures were 83 % and 15 % respectively. Undertriaged patients had significantly more neurosurgical injuries and were significantly more often transferred from an acute care hospital.DiscussionOver- and undertriage are almost the same as before the criteria were revised, and higher thanrecommended levels.ConclusionsRevision of the TTA criteria has not improved triage, and further measures are necessary to achieveacceptable levels.

Patient experiences of initial trauma care

“…However, there are other studies that have found that there was no change in over-and undertriage rates after criteria revisions. 78…”

“…Mechanism of injury as only criteria for activation of trauma team, is on the other hand less secure on what care level to alert. Recent trauma research has shown that only mechanism of injury and no deterioration in physiology or any of the specific anatomic injuries often leads to over triage and therefore should activate a limited trauma team 77,78 . In a Norwegian study different rates of over-and under triage are shown to vary depending on who performs the triage.…”

Trauma team activation – common rules, common gain

“…The MOI criteria have in the same studies been shown to be responsible for a large part of the overtriage, while physiological criteria are the most accurate criteria for identifying seriously injured patients. Attempts at modifying the criteria to improve triage precision, including the removal of some of the MOI criteria, has not yet been successful . A two‐tiered trauma team activation protocol (admission with a large trauma team or a smaller team) is recommended by the ACS‐COT for trauma centres .…”

“…Undertriage is reported to be 13–28% . In addition, we know that only 50% of seriously injured patients in Norway are offered pre‐hospital advanced care .…”

“…There are indications that undertriage affects older trauma patients and patients with neurosurgical injuries. An attempt to reduce undertriage by revision of the trauma team activation criteria did not change undertriage at all …”