Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU® may significantly improve overtriage – a cross sectional study

Abstract

BackgroundNo consensus exists in the literature on the use of uniform emergency room trauma team activation criteria (ERTTAC). Today excessive over- or undertriage rates continue to be a challenge for most trauma centres. Application of ERTTAC, published for use in the German TraumaNetwork DGU®, at a Swiss trauma centre resulted in a high overtriage rate. The aim of the investigation was to analyse the ERTTAC in detail with the intention of possible improvement.MethodsThe investigation included consecutive adult (age > 15 years) trauma patients treated at the emergency department of a level II trauma centre from 01.01.2013–31.12.2015. All data were collected prospectively. To identify over- and undertriage, patients with an Injury Severity Score (ISS) > 15 were defined as requiring specific emergency room (ER) management. ANOVA, Student’s t-test and chi-square analysis were used for statistical analysis with mean values ± standard deviation.Results1378 adult injured (64% male) received ER trauma team treatment (mean age 48.3 ± 21.2 years; ISS 9.7 ± 9.6) during the observation period. Of those, 326 ER patients (23.7%) were diagnosed with an ISS > 15, which proved to be an overtriage of 76.3%. 80/406 trauma patients with an ISS > 15 were not referred to the ER, resulting in an actual undertriage rate of 19.7%, mainly because the criteria list was not observed. Effectively applying ERTTAC according to the protocol in all cases would have reduced undertriage to 2.0% (8/406). The most frequent trigger for trauma team activation was injury mechanism (65%). A simulation revealed that omitting the criterion ‘passenger of car or truck’ (n = 326) would have prevented overtriage in 257 cases, as such lowering overtriage rate to 62.4% and at the same time increasing undertriage by only 8 cases to 7.1%.ConclusionApplication of ERTTAC as published for TraumaNetwork DGU® resulted in a lower undertriage but higher overtriage rate than recommended by the American College of Surgeons. Omitting the criterion ‘passenger of car or truck’ markedly improved overtriage with only a minimal increase in undertriage.Trial registrationNCT02165137; retrospectively registered 11. June 2014.

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

“…Previous studies have shown increases in overtriage rates when efforts were made to decrease undertriage, and similarly, increases in undertriage rates, when attempting to reduce overtriage. [10][11][12][13] The motivation to avoid excessive undertriage could prompt physicians to overtriage to compensate, knowing that the allowable rate for those cases is much greater. Our data, however, indicate that having ISS guidelines at their fingertips allowed the trauma physicians to appropriately triage patients with lower ISS, incidentally improving overtriage rates as well as undertriage rates.…”

Schockraum- und Schwerverletztenversorgung als „Verlustgeschäft“

“…Konsekutive Analyse aller 2018 im SR gemäß standardisierten Kriterien [ 3 ] und/oder infolge eines signifikanten Traumas (New Injury Severity Score, NISS ≥8) [ 15 ] notfallmäßig (innert 24 h) stationär versorgter Verletzten eines Schweizer Zentrumspitals. Die Studie war Teil eines von der zuständigen Ethikkommission (PB_2018-00079 – AG/SO 2012-008) genehmigten Versorgungsforschungsprojektes (NCT02165137).…”

Detailed information gain and therapeutic impact of whole body computed tomography supplementary to conventional radiological diagnostics in blunt trauma emergency treatment: a consecutive trauma centre evaluation

“…We excluded penetrating trauma from this study to homogenize the study population, because it is typically associated with different injuries and treatment regimens, and our cases are few. The decision to use WBCT in individual cases was taken by the trauma leader on duty, which could be seen as a potential confounder, even though internal hospital guidelines recommend its standard use as soon as trauma team activation criteria [17] were actually fulfilled after primary evaluation of the patient in the ER. The evaluation is restricted to the cohort investigated due to its monocenter design and, ultimately, includes more older or less severely injured than several other study groups [29][30][31][32][33].…”