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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2018 | Original research

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

Authors: Ole-Petter Vinjevoll, Oddvar Uleberg, Elaine Cole

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2018

Abstract

Background

Sensitive 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.

Methods

This 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.

Results

A 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.

Conclusions

Severe 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.

Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013. Inj Prev. 2016; https://doi.org/10.1136/injuryprev-2015-041616.

MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A National Evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–78.CrossRefPubMed

van Rein EAJ, Houwert RM, Gunning AC, Lichtveld R, Leenen LPH, van Heijl M. Accuracy of prehospital triage protocols in selecting major trauma patients: a systematic review. J Trauma Acute Care Surg. 2017; https://doi.org/10.1097/TA.0000000000001516.

Dehli T, Uleberg O, Wisborg T. Trauma team activation - common rules, common gain. Acta Anaesthesiol Scand. 2018;62:144–6. https://doi.org/10.1111/aas.13013.CrossRefPubMed

American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient. Chicago; 2014.

Uleberg O, Vinjevoll OP, Eriksson U, Aadahl P, Skogvoll E. Overtriage in trauma what are the causes? Acta Anaesthesiol Scand. 2007;51:1178–83.PubMed

Rehn M, Lossius HM, Tjosevik KE, Vetrhus M, Østebø O, Eken T, et al. Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma Centre. Br J Surg. 2012;99:199–208.CrossRefPubMedPubMedCentral

Dehli T, Monsen SA, Fredriksen K, Bartnes K. Evaluation of a trauma team activation protocol revision: a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2016;24:105.CrossRefPubMedPubMedCentral

Rehn M, Eken T, Krüger AJ, Steen PA, Skaga NO, Lossius HM. Precision of field triage in patients brought to a trauma Centre after introducing trauma team activation guidelines. Scand J Trauma Resusc Emerg Med. 2009;17:1.CrossRefPubMedPubMedCentral

10.

Kann SH, Hougaard K, Christensen EF. Evaluation of pre-hospital trauma triage criteria: a prospective study at a Danish level I trauma Centre. Acta Anaesthesiol Scand. 2007;51:1172–7.PubMed

11.

Newgard CD, Fu R, Zive D, Rea T, Malveau S, Daya M, et al. Prospective Validation of the national field triage guidelines for identifying seriously injured persons. J Am Coll Surg. 2016;222:146–58.e2.CrossRefPubMed

12.

Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on field triage, 2011. MMWR Recomm Rep. 2012;61:1–20.PubMed

13.

Uleberg O, Kristiansen T, Pape K, Romundstad PR, Klepstad P. Trauma care in a combined rural and urban region: an observational study. Acta Anaesthesiol Scand. 2017;61:346–56. https://doi.org/10.1111/aas.12856.CrossRefPubMed

14.

Statistics Norway. https://ssb.no/en. Accessed 30 Nov 2017.

15.

Gennarelli TA, Wodzin E. AIS 2005 - Abbreviated Injury Scale. Association for the Advancement of Automotive Medicine (AAAM). Barrington; 2005.

16.

Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.CrossRefPubMed

17.

Boyd CR, Boyd CR, Tolson MA, Tolson MA, Copes WS, Copes WS. Evaluating trauma care: the TRISS method. J Trauma. 1987;27:370–8.CrossRefPubMed

18.

Mackersie R. History of trauma field triage development and the American College of Surgeons criteria. Prehosp Emerg Care. 2006;10:287–94.CrossRefPubMed

19.

Committee on Trauma of the American College of Surgeons. Hospital and prehospital resources for optimal care of the injured patient. Bull Am Coll Surg. 1986;71:4–23.

20.

Larsen KT, Uleberg O, Skogvoll E. Differences in trauma team activation criteria among Norwegian hospitals. Scand J Trauma Resusc Emerg Med. 2010; https://doi.org/10.1186/1757-7241-18-21.

21.

Fishman PE, Shofer FS, Robey JL, Zogby KE, Reilly PM, Branas CC, et al. The impact of trauma activations on the care of emergency department patients with potential acute coronary syndromes. Ann Emerg Med. 2006;48:347–53.CrossRefPubMed

22.

Zocchi MS, Hsia RY, Carr BG, Sarani B, Pines JM. Comparison of mortality and costs at trauma and nontrauma centers for minor and moderately severe injuries in California. Ann Emerg Med. 2016;67:56–67.e5. https://doi.org/10.1016/j.annemergmed.2015.04.021.CrossRefPubMed

23.

Hammer PM, Storey AC, Bell T, Bayt D, Hockaday MS, Zarzaur BL, et al. Improving geriatric trauma outcomes: a small step toward a big problem. J Trauma Acute Care Surg. 2016;81:162–7.CrossRefPubMed

24.

Palmer C. Major trauma and the injury severity score--where should we set the bar? Annu Proc Assoc Adv Automot Med. 2007;51:13–29.PubMedPubMedCentral

25.

Simon BJ, Simon BJ, Legere P, Legere P, Emhoff T, Emhoff T, et al. Vehicular trauma triage by mechanism: avoidance of the unproductive evaluation. J Trauma. 1994;37:645–9.CrossRefPubMed

26.

Shatney CH, Shatney CH, Sensaki K, Sensaki K, Falcone RE, Hinsdale JG, et al. Trauma team activation for ‘mechanism of injury’ blunt trauma victims: time for a change? J Trauma. 1994;37:275–82.CrossRefPubMed

27.

Henry MC, Alicandro JM, Hollander JE, Moldashel JG, Cassara G, Thode HC. Evaluation of American college of surgeons trauma triage criteria in a suburban and rural setting. Am J Emerg Med. 1996;14:124–9.CrossRefPubMed

28.

Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. EMJ. 2015;32:911–5.CrossRefPubMed

29.

Newgard CD, Rudser K, Hedges JR, Kerby JD, Stiell IG, Davis DP, et al. A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality. J Trauma. 2010;68:452–62.CrossRefPubMedPubMedCentral

30.

Smithson L, Morrell J, Kowalik U, Flynn W, Guo WA. Injury in the aged: geriatric trauma care at the crossroads. J Trauma Acute Care Surg. 2015;78:1162–7.CrossRefPubMed

31.

Rehn M. Improving adjustments for older age in pre-hospital assessment and care. Scand J Trauma Resusc Emerg Med. 2013; https://doi.org/10.1186/1757-7241-21-4.

Title: Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study
Authors: Ole-Petter Vinjevoll
Oddvar Uleberg
Elaine Cole
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2018
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-018-0533-y

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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