Trauma team activation: simplified criteria safely reduces overtriage

A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study

“…3) using the OLD triage system. 9 In the patients who were undertriaged, all were immediately evaluated by the ED staff, and then seen as ''trauma consults'' by the trauma service. They were all hemodynamically stable on presentation.…”

“…Our hospital is a Level II trauma center located in Pierce County, Washington. Based on the prior studies at our institution, 8,9 we changed our activation criteria from the 3-tiered Pierce County EMS system to a more simplified 2-tiered system beginning in April 2010 (Fig. 2).…”

A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons

“…Such simplification has the potential to make triage more efficient and accurate but will require a clear understanding of the criteria and the age-specific variations of blood pressure and respiratory distress. 33 Although the proposed eight criteria would increase the overtriage rate compared with the ACS-6, it would also reduce the undertriage rate to nearly the rate of using 23 individual criteria. The validity and the reliability of a revised pediatric triage list for highest activation at trauma centers will need to be further assessed through a prospective study.…”

“…6,24,30,32 An alternative method is to examine resources actually used by the trauma patient during the resuscitation. 24,33 If the definition of necessary resources is too narrow, it is possible that the overtriage rate will be seen as inappropriately elevated. An example of such a problem was a study that evaluated the ACS-6 using only an ''emergency transfer to the OR within an hour'' as the determination of appropriate triage for pediatric patients.…”

The Efficacy of a Two-Tiered Trauma Activation System at a Level I Trauma Center

“…However, on review of their three-tier system, they found that systolic blood pressure Ͻ90 and GCS Ͻ8 were the strongest predictors of mortality but that full trauma team presence on arrival had no impact on long-term (Ͼ38 days) survival. Lehman et al 13 studied their three-tier system with 12 criteria and determined that the four ACS-COT criteria requiring attending surgeon presence were sufficient to identify patients requiring full trauma team activation.…”