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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2016 | Original research

Evaluation of a trauma team activation protocol revision: a prospective cohort study

Authors: Trond Dehli, Svein Arne Monsen, Knut Fredriksen, Kristian Bartnes

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2016

Abstract

Background

Correct triage based on prehospital information contributes to a better outcome for potentially seriously injured patients. In 2011 we changed the trauma team activation (TTA) criteria in our center in order to improve the high over- and undertriage properties of the protocol. Five criteria that were unable to predict severe injury were removed. In the present study, we evaluated the protocol revision by comparing over- and undertriage in the former and present set of criteria.

Methods

All severely injured patients (Injury Severity Score (ISS) > 15) and all patients admitted with TTA in the period of 01.01.2013 – 31.12.2014 were included in the study. We defined overtriage as the fraction of patients with TTA when ISS ≤15 and undertriage as the fraction of patients without TTA when ISS > 15. We also evaluated triage with the occurrence of emergency procedures immediately after admission.

Results

324 patients were included, 164 patients had ISS>15, 287 were admitted with TTA. Over- and undertriage were 74 % and 28 % respectively. When we used emergency procedure as reference, the figures were 83 % and 15 % respectively. Undertriaged patients had significantly more neurosurgical injuries and were significantly more often transferred from an acute care hospital.

Discussion

Over- and undertriage are almost the same as before the criteria were revised, and higher thanrecommended levels.

Conclusions

Revision of the TTA criteria has not improved triage, and further measures are necessary to achieveacceptable levels.

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

Kristiansen T, Søreide K, Ringdal K, Rehn M, Krüger AJ, Reite A, et al. Trauma systems and early management of severe injuries in Scandinavia: review of the current state current state. Injury. 2010;41:442–52.CrossRef

The American College of Surgeons. Resources for optimal care of the injured patient 2006 [Internet]. 2006th ed. J. Am. Coll. Surg. Chicago IL: American College of Surgeons Committee on Trauma; 2006.

Larsen KT, Uleberg O, Skogvoll E. Differences in trauma team activation criteria among Norwegian hospitals. Scand J Trauma Resusc Emerg Med. 2010;18:21.CrossRefPubMedPubMedCentral

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

Clemmesen ML, Rytter S, Birch K, Lindholt JS, Jensen SS, Troelsen S. [Should high-energy traumas always result in a trauma team call?]. Ugeskr. Laeger. 2006;168:2916–20.

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

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

Krüger AJ, Hesselberg N, Abrahamsen GT, Bartnes K. [When should the trauma team be activated?]. Tidsskr den Nor lægeforening. 2006;126:1335–7.

10.

Meisler R, Thomsen AB, Abildstrøm H, Guldstad N, Borge P, Rasmussen SW, et al. Triage and mortality in 2875 consecutive trauma patients. Acta Anaesthesiol Scand. 2010;54:218–23.CrossRefPubMed

11.

Wisborg T, Castrèn M, Lippert A, Valsson F, Wallin CJ. Training trauma teams in the Nordic countries: an overview and present status. Acta Anaesthesiol Scand. 2005;49:1004–9.CrossRefPubMed

12.

Dehli T, Fredriksen K, Osbakk SA, Bartnes K. Evaluation of a university hospital trauma team activation protocol. Scand J Trauma Resusc Emerg Med. 2011;19:18.CrossRefPubMedPubMedCentral

13.

Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997;43:922–5. discussion 925–6.CrossRefPubMed

14.

Association for the Advancement of Automotive Medicine. Abbreviated Injury Scale 2005. Barrington, IL, USA: Update 2008; 2008.

15.

Baker S, O’Neill B, Haddon W, Long W. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma-Injury. 1974;14:187–96.CrossRef

16.

Stordahl H, Passas E, Hopland A, Nielsen EW. Nine out of ten trauma calls to a Norwegian hospital are avoidable: a retrospective analysis. BMC Emerg Med. 2015;15.

17.

Jenkins P, Rogers J, Kehoe A, Smith JE. An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre. Emerg Med J. 2015;32:364–7.CrossRefPubMed

18.

Rehn M, Lossius HM, Tjosevik KE, Vetrhus M, Østebø O, Eken T. Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre. Br J Surg. 2012;99(2):199–208.CrossRefPubMedPubMedCentral

19.

Kehoe A, Rennie S, Smith JE. Glasgow coma scale is unreliable for the prediction of severe head injury in elderly trauma patients. Emerg Med J. 2014;32:613–5.CrossRefPubMed

20.

Bressan S, Franklin KL, Jowett HE, King SK, Oakley E, Palmer CS. Establishing a standard for assessing the appropriateness of trauma team activation : a retrospective evaluation of two outcome measures. Emerg Med J. 2015;32:716–21.CrossRefPubMed

21.

Falcone RA, Haas L, King E, Moody S, Crow J, Moss A, et al. A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons. J Trauma Acute Care Surg. 2012;73:377–84.CrossRefPubMed

22.

No Title [Internet]. [cited 2016 Jan 1]. Available from: http://traumeplan.no/wp-content/uploads/2015/04/Traumesystem-i-Norge-2015.pdf. Accessed 24 Aug 2016.

Title: Evaluation of a trauma team activation protocol revision: a prospective cohort study
Authors: Trond Dehli
Svein Arne Monsen
Knut Fredriksen
Kristian Bartnes
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2016
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-016-0295-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of a trauma team activation protocol revision: a prospective cohort study

Abstract

Background

Methods

Results

Discussion

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Discussion

Conclusions

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