Trauma team activation – common rules, common gain

Dehli, Trond; Uleberg, Oddvar; Wisborg, Torben

doi:10.1111/aas.13013

Cited by 8 publications

(8 citation statements)

References 10 publications

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“…Failure to recognise severe injury, known as undertriage has been found to cause delayed diagnosis and therapeutic interventions, and is associated with missed injuries and increased morbidity [ 2 , 3 ]. Conversely overtriage might result in unnecessary use of available hospital resources by alerting the trauma team for those with minor injury [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

Vinjevoll

Uleberg

Cole

2018

Scand J Trauma Resusc Emerg Med

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BackgroundSensitive decision making tools should assist prehospital personnel in the triage of injured patients, identifying those who require immediate lifesaving interventions and safely reducing unnecessary under- and overtriage. In 2014 a new trauma team activation (TTA) tool was implemented in Central Norway. The overall objective of this study was to evaluate the ability of the new TTA tool to identify severe injury.MethodsThis was a multi-center observational cohort study with retrospective data analysis. All patients received by trauma teams at seven hospitals in Central Norway between 01.01.2015 to 31.12.2015 were included. Severe injury was defined as Injury Severity Score (ISS) > 15. Overtriage was defined as the rate of patients with TTA and ISS < 15, whilst patients with TTA and ISS > 15 were defined as correctly triaged.ResultsA total of 1141 patients were identified, of which 998 were eligible for triage criteria analysis. Median age was 35 years (IQR 20–58) and the male proportion was 67%. Mechanism of injury was predominantly blunt trauma (96%) with transport related accidents (62%) followed by falls (22%) the most common. Overall, median injury severity score (ISS) was low and severely injured patients (ISS > 15) comprised 13% of the cohort. Utility of specific TTA criteria were: physiology 20%, anatomical injury 21%, mechanism of injury (MOI) 53% and special causes 6%. Overtriage among all patients was 87%, and for those with physiologic criteria 66%, anatomical injury 82%, mechanism of injury 97% and special causes criteria 92%, respectively.ConclusionsSevere injury was infrequent and there was a substantial rate of overtriage. The ability of the TTA tool was relatively insensitive in identifying severe injury, but showed increased performance when utilizing physiologic and anatomical injury criteria. Many of the TTA mechanism of injury criteria might be considered for removal from the triage tool due to substantial rates of overtriage. This has relevance for the proposed development of national Norwegian TTA criteria.

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Section: Introductionmentioning

confidence: 99%

Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

Vinjevoll

Uleberg

Cole

2018

Scand J Trauma Resusc Emerg Med

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“…Las diversas fuentes muestran que los miembros que conforman más frecuentemente los equipos de trauma son médicos anestesiólogos, emergenciólogos, cirujanos, residentes de emergencias, residentes de cirugía, profesionales en enfermería, técnicos de imagen, técnicos de laboratorio, anotadores y en menor frecuencia profesionales de otras áreas como: residentes de anestesia, médicos internos, terapistas respiratorios, instrumentadores quirúrgicos, entre otros. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]…”

Section: Resultsunclassified

Implementación de un código de trauma en un servicio de emergencias de un hospital nacional

Lugo

Núñez

2021

AMC

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Objetivo: desarrollar una propuesta accesible a la realidad local de un hospital general terciario (Hospital Calderón Guardia) para la implementación de un código de trauma, basada en la mejor evidencia médico científica disponible.Métodos: se realizó una revisión de la bibliografía; se buscaron los trabajos de investigación publicados a nivel nacional e internacional sobre la conformación y criterios relativos al código de trauma, su implementación, sus desafíos, y sus limitaciones; mediante 3 buscadores: Scielo, Pubmed y Ovid. Se incluyeron estudios con diversa metodología, disponibles en inglés o español.Resultados: Treinta artículos publicados en revistas indexadas fueron seleccionados y la información se agrupó en las siguientes categorías: Conformación del equipo de trauma en la activación de los códigos para cada hospital, criterios de activación, niveles de activación, experiencia local y limitaciones. Dicha información permitió identificar dos elementos principales para conseguir un beneficio: la conformación de un equipo multidisciplinario de primera respuesta para los pacientes más graves y la estandarización de criterios específicos para la activación de dicho equipo; entonces, se procedió a elaborar y proponer un modelo viable y concordante con las características del servicio hospitalario.Conclusión: la implementación hospitalaria de un modelo de código de trauma supone un impacto positivo en los desenlaces de morbi-mortalidad, a través de dos 2 mecanismo principales: la conformación de un equipo multidisciplinario de primera respuesta para los pacientes más graves y la estandarización de criterios específicos para la activación de dicho equipo; por lo que se elaboró un modelo ajustado a las necesidades y recursos del hospital.

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“…It is possible for a scoring system with low sensitivity to classify a major trauma as a minor one, thus leading to inadequate trauma management and transportation to an inappropriate trauma centre, ultimately resulting in higher mortality rates [ 13 ]. On the other hand, the low specificity of a scoring system can also result in minor traumas unnecessarily being treated as major ones, leading to a heavy workload at secondary trauma centers and resulting in delays in the management of major traumas [ 15 ]. In most trauma systems worldwide, a substantial number of severely injured patients are not transported to the appropriate level trauma centre [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Prehospital Trauma Scoring Systems for Evaluation of Trauma Severity and Prediction of Outcomes

et al. 2023

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Introduction: Trauma scoring systems in prehospital settings are supposed to ensure the most appropriate in-hospital treatment of the injured. Aim of the study: To determine the sensitivity and specificity of the CRAMS scale (circulation, respiration, abdomen, motor and speech), RTS score (revised trauma score), MGAP (mechanism, Glasgow Coma Scale, age, arterial pressure) and GAP (Glasgow Coma Scale, age, arterial pressure) scoring systems in prehospital settings in order to evaluate trauma severity and to predict the outcome. Materials and Methods: A prospective, observational study was conducted. For every trauma patient, a questionnaire was initially filled in by a prehospital doctor and these data were subsequently collected by the hospital. Results: The study included 307 trauma patients with an average age of 51.7 ± 20.9. Based on the ISS (injury severity score), severe trauma was diagnosed in 50 (16.3%) patients. MGAP had the best sensitivity/specificity ratio when the obtained values indicated severe trauma. The sensitivity and specificity were 93.4 and 62.0%, respectively, for an MGAP value of 22. MGAP and GAP were strongly correlated with each other and were statistically significant in predicting the outcome of treatment (OR 2.23; 95% Cl 1.06–4.70; p = 0.035). With a rise of one in the MGAP score value, the probability of survival increases 2.2 times. Conclusion: MGAP and GAP, in prehospital settings, had higher sensitivity and specificity when identifying patients with a severe trauma and predicting an unfavorable outcome than other scoring systems.

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Trauma team activation – common rules, common gain

Cited by 8 publications

References 10 publications

Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

Implementación de un código de trauma en un servicio de emergencias de un hospital nacional

Prehospital Trauma Scoring Systems for Evaluation of Trauma Severity and Prediction of Outcomes

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