Let the Surgeon Sleep: Trauma Team Activation for Severe Hypotension

Shapiro, Marc J.; McCormack, Jane E.; Jen, James

doi:10.1097/ta.0b013e31818c262f

Cited by 8 publications

(6 citation statements)

References 25 publications

(21 reference statements)

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“…However, such broad inclusion criteria would have significant implications for the delivery of care and possible overtriage, 46 given the limited resources available for trauma care. Currently, there is much debate in the emergency and trauma community about inappropriate trauma “activations” (which alert the hospital to the need for trauma resources such as the surgical and anesthesia team) from the field during the prehospital phase, 47–49 or while in hospital, 50 and unnecessary transfers that deplete the hospital of needed resources and other patients. 51 In fact, studies of centers that do have age as a criterion for automatic trauma activation demonstrate that such regulation can result in unnecessary and costly initiations of a multidisciplinary response.…”

Section: Commentmentioning

confidence: 99%

Factors Associated With Trauma Center Use for Elderly Patients With Trauma

Hsia¹

2011

Arch Surg

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Objectives To estimate the likelihood of trauma center admission for injured elderly patients with trauma, determine trends in trauma center admissions, and identify factors associated with trauma center use for elderly patients with trauma. Design Retrospective analysis. Setting Acute care hospitals in California. Patients All patients hospitalized for acute traumatic injuries during the period from January 1, 1999, to December 31, 2008 (n=430 081). Patients who had scheduled admissions for nonacute or minor trauma were excluded. Main Outcome Measure Likelihood of admission to level I or II trauma center was calculated according to age categories after adjusting for patient and system factors. Results Of 430 081 patients admitted to California acute care hospitals for trauma-related diagnoses, 27% were older than 65 years. After adjusting for demographic, clinical, and system factors, compared with trauma patients aged 18–25 years, the odds of admission to a trauma center decreased with increasing age; patients aged 26–45 years had lower odds (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71–0.80) of being admitted to a trauma center for their injuries than did patients 46–65 years of age (OR, 0.57; 95% CI, 0.54–0.60), patients 66–85 years of age (OR, 0.35; 95% CI, 0.30–0.41), and patients older than 85 years (OR, 0.30; 95% CI, 0.25–0.36). Similar patterns were found when stratifying the analysis by trauma type and severity. Living more than 50 miles away from a trauma center (OR, 0.03; 95% CI, 0.01–0.06) and lack of county trauma center (OR, 0.17; 95% CI, 0.09–0.35) were also predictors of not receiving trauma care. Conclusion Age and likelihood of admission to a trauma center for injured patients were observed to be inversely proportional after controlling for other factors. System-level factors play a major role in determining which injured patients receive trauma care.

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Section: Commentmentioning

confidence: 99%

Factors Associated With Trauma Center Use for Elderly Patients With Trauma

Hsia¹

2011

Arch Surg

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“…Lehman et al, 21,22 reassessing triage criteria for trauma team activation at their center, deemed SBP of Ͻ100 mm Hg along with other variables as better criterion. However, Shapiro et al 23 found no harm in choosing a SBP of Ͻ80 mm Hg as definition of hypotension for trauma team activation at their trauma center when using resource allocation as the key variable.…”

mentioning

confidence: 98%

Presenting Blood Pressure in Traumatic Brain Injury: A Bimodal Distribution of Death

Zafar

Millham

Chang

et al. 2011

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…The majority of the data currently used to design triage systems comes from experiences at Level 1 centers, and may not take into account the significant differences in resources and infrastructure at Level 2 or 3 centers. 7 Our Level 2 trauma center had previously used the Pierce Country emergency medical system (EMS) Trauma Triage System (Fig. 1), a 3-tiered graded system of trauma activation that considered physiologic, demographic, and mechanistic variables to determine the level of trauma team activation.…”

mentioning

confidence: 99%