Evaluation of a university hospital trauma team activation protocol

Abstract

BackgroundAdmission with a multidisciplinary trauma team may be vital for the severely injured patient, as this facilitates rapid diagnosis and treatment. On the other hand, patients with minor injuries do not need the trauma team for adequate care. Correct triage is important for optimal resource utilization. The aim of the study was to evaluate our criteria for activating the trauma team, and identify suboptimal criteria that might be changed in the interest of precision.MethodsThe study is an observational, retrospective cohort-study. All patients admitted with the trauma team (n = 382), all severely injured (Injury Severity Score (ISS) >15) (n = 161), and all undergoing an emergency procedure aimed at counteracting compromised airways, respiration or circulation at our hospital (n = 142) during 2006-2007 were included. Data were recorded from the admission records and the electronic patient records. The trauma team activation protocol was evaluated against the occurrence of severe injury and the occurrence of emergency procedures.ResultsA total of 441 patients were included. The overtriage was 71% and undertriage 32% when evaluating against ISS >15 as the standard of reference. When occurrence of emergency procedures was held as the standard of standard of reference, the over- and undertriage was 71% and 21%, respectively. Mechanism of injury-criteria for trauma team activation contributed the most to overtriage. The emergency procedures performed were mostly endotracheal intubation and external fixation of fractures. Less than 3% needed haemostatic laparotomy or thoracotomy. Approximately 2/3 of the overtriage represented isolated head or cervical spine injuries, and/or interhospital transfers.ConclusionsThe over- and undertriage of our protocol are both too high. To decrease overtriage we suggest omissions and modifications of some of the criteria. To decrease undertriage, transferred patients and patients with head injuries should be more thoroughly assessed against the trauma team activation criteria.

Emergency resuscitative thoracotomy performed in European civilian trauma patients with blunt or penetrating injuries: a systematic review

“…The study descriptives, patient demographics and main findings are reported in Table 1. A further two publications were found from Norway and Ireland [23, 24]. Upon author contact, we were informed that 5 resuscitative emergency thoracotomies were performed, with no survivors in Tromsø, Norway.…”

“…Notably, of the 70 ETs, 16 were for cardiac injury, of which only 5 survived (32 %) [33]. In a study from Northern Norway ( n  = 142) [23], <3 % of all patients required hemostatic surgery on admission, and only 5 patients had an emergency thoracotomy, with no survivors. In another study from Dublin [24], 5 % of penetrating trauma victims had a thoracotomy, although no further data was provided on indication nor on outcome in this report.…”

“…In another study from Dublin [24], 5 % of penetrating trauma victims had a thoracotomy, although no further data was provided on indication nor on outcome in this report. However, these reports indicate that emergency salvage procedures are not commonly performed in European trauma populations [23, 24, 33]. …”

Trauma team activation – common rules, common gain

“…It is no surprise, thus, that several studies in Scandinavia reports an overtriage of up to 70%, and even as high as 90% in some centres . 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.…”

Prediction of mortality rate of trauma patients in emergency room at Cipto Mangunkusumo Hospital by several scoring systems

“…6 They can also be used for clinical decision making when the trauma patient has just arrived at the emergency room (ER). 7,8 Trauma is a time-sensitive condition and well recognized as one of the main challenges in modern health care. [1][2][3][4] Easy-to-use trauma scoring systems inform physicians of the severity of the trauma in patients and help them to decide the course of trauma management.…”