Skip to main content
Top
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2010

Open Access 01-12-2010 | Original research

Differences in trauma team activation criteria among Norwegian hospitals

Authors: Kristin T Larsen, Oddvar Uleberg, Eirik Skogvoll

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2010

Login to get access

Abstract

Background

To ensure the rapid and correct triage of patients in potential need of specialized treatment, Norwegian hospitals are expected to establish trauma teams with predefined criteria for their activation. The objective of this study was to map and describe the criteria currently in use.

Methods

We undertook a cross-sectional survey in the summer of 2008, using structured telephone interviews to all Norwegian hospitals that might admit severely injured patients.

Results

Forty-nine hospitals were included, of which 48 (98%) had a trauma team and 20 had a hospital-based trauma registry. Criteria for trauma team activation were found at 46 (94%) hospitals. No single criterion was common to all hospitals. The median number of criteria per hospital was 23 (range 8-40), with a total number of 156 and wide variation with respect to physiological "cut-off" values. The mechanism of injury was commonly in use despite a well-known, large over-triage rate.

Conclusions

In recent years, Norwegian hospitals have gradually established trauma teams and criteria for their activation. These criteria show considerable variation, including physiological "cut-off" values.
Appendix
Available only for authorised users
Literature
1.
go back to reference World Health Organization: The global burden of disease: 2004 update. Geneva. 2004 World Health Organization: The global burden of disease: 2004 update. Geneva. 2004
2.
go back to reference Mackersie RC: History of trauma field triage development and the American College of Surgeons Criteria. Prehosp Emerg Care. 2006, 10: 287-94. 10.1080/10903120600721636.CrossRefPubMed Mackersie RC: History of trauma field triage development and the American College of Surgeons Criteria. Prehosp Emerg Care. 2006, 10: 287-94. 10.1080/10903120600721636.CrossRefPubMed
3.
go back to reference Freeark RJ: The trauma centres - its hospitals, head injuries, helicopters, and heroes. J Trauma. 1983, 23: 173-83. 10.1097/00005373-198303000-00001.CrossRefPubMed Freeark RJ: The trauma centres - its hospitals, head injuries, helicopters, and heroes. J Trauma. 1983, 23: 173-83. 10.1097/00005373-198303000-00001.CrossRefPubMed
4.
go back to reference American College of Surgeons: Optimal hospital resources for care of the seriously injured. Bull Am Coll Surg. 1976, 61: 15-22. American College of Surgeons: Optimal hospital resources for care of the seriously injured. Bull Am Coll Surg. 1976, 61: 15-22.
5.
go back to reference American College of Surgeons: Hospital and prehospital resources for the optimal care of the injured patient. 1986, Chicago, IL: American College of Surgeons American College of Surgeons: Hospital and prehospital resources for the optimal care of the injured patient. 1986, Chicago, IL: American College of Surgeons
6.
go back to reference American College of Surgeons: Resources for the optimal care of the injured patient. 1990, Chicago, IL: American College of Surgeons American College of Surgeons: Resources for the optimal care of the injured patient. 1990, Chicago, IL: American College of Surgeons
7.
go back to reference American College of Surgeons: Resources for the optimal care of the injured patient. 1993, Chicago, IL: American College of Surgeons American College of Surgeons: Resources for the optimal care of the injured patient. 1993, Chicago, IL: American College of Surgeons
8.
go back to reference American College of Surgeons: Resources for the optimal care of the injured patient. 1999, Chicago, IL: American College of Surgeons American College of Surgeons: Resources for the optimal care of the injured patient. 1999, Chicago, IL: American College of Surgeons
9.
go back to reference American College of Surgeons: Resources for the optimal care of the injured patient. 2006, Chicago, IL: American College of Surgeons American College of Surgeons: Resources for the optimal care of the injured patient. 2006, Chicago, IL: American College of Surgeons
10.
go back to reference Sasser SM, Hunt RC, Sullivent EE, Wald MM, Mitchko J, Jurkovich GJ, Henry MC, Salomone JP, Wang SC, Galli RL, Cooper A, Brown LH, Sattin RW, National Expert Panel on Field Triage, Centers for Disease Control and Prevention (CDC): Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep. 2009, 58: 1-35.PubMed Sasser SM, Hunt RC, Sullivent EE, Wald MM, Mitchko J, Jurkovich GJ, Henry MC, Salomone JP, Wang SC, Galli RL, Cooper A, Brown LH, Sattin RW, National Expert Panel on Field Triage, Centers for Disease Control and Prevention (CDC): Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep. 2009, 58: 1-35.PubMed
11.
go back to reference Utter GH, Maier RV, Rivara FP, Mock CN, Jurkovich GJ, Nathens AB: Inclusive trauma systems: do they improve triage or outcomes of the severely injured?. J Trauma. 2006, 60: 529-35. 10.1097/01.ta.0000204022.36214.9e. discussion 535-37CrossRefPubMed Utter GH, Maier RV, Rivara FP, Mock CN, Jurkovich GJ, Nathens AB: Inclusive trauma systems: do they improve triage or outcomes of the severely injured?. J Trauma. 2006, 60: 529-35. 10.1097/01.ta.0000204022.36214.9e. discussion 535-37CrossRefPubMed
12.
go back to reference MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO: A national evaluation of the effect of trauma-centre care on mortality. New Engl J Med. 2006, 354: 366-378. 10.1056/NEJMsa052049.CrossRefPubMed MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO: A national evaluation of the effect of trauma-centre care on mortality. New Engl J Med. 2006, 354: 366-378. 10.1056/NEJMsa052049.CrossRefPubMed
13.
go back to reference Petrie D, Lane P, Stewart TC: An evaluation of patient outcomes comparing trauma team activation versus trauma team not activated using TRISS analysis. J Trauma. 1996, 41: 870-5. 10.1097/00005373-199611000-00020.CrossRefPubMed Petrie D, Lane P, Stewart TC: An evaluation of patient outcomes comparing trauma team activation versus trauma team not activated using TRISS analysis. J Trauma. 1996, 41: 870-5. 10.1097/00005373-199611000-00020.CrossRefPubMed
14.
go back to reference Gwinnutt CL, Driscoll PA, Whittaker J: Trauma systems - state of the art. Resuscitation. 2001, 48: 17-23. 10.1016/S0300-9572(00)00314-2.CrossRefPubMed Gwinnutt CL, Driscoll PA, Whittaker J: Trauma systems - state of the art. Resuscitation. 2001, 48: 17-23. 10.1016/S0300-9572(00)00314-2.CrossRefPubMed
15.
go back to reference 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. 10.1016/S0735-6757(96)90117-5.CrossRefPubMed 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. 10.1016/S0735-6757(96)90117-5.CrossRefPubMed
16.
go back to reference National report by Committee appointed by the Norwegian health authorities: Trauma system in Norway - Suggestions for organizing the treatment of severely injured patients. Oslo. 2007 National report by Committee appointed by the Norwegian health authorities: Trauma system in Norway - Suggestions for organizing the treatment of severely injured patients. Oslo. 2007
18.
go back to reference Brattebo G, Wisborg T, Hoylo T: Organization of trauma admissions at Norwegian hospitals. Tidsskr Nor Laegeforen. 2001, 121: 2364-7.PubMed Brattebo G, Wisborg T, Hoylo T: Organization of trauma admissions at Norwegian hospitals. Tidsskr Nor Laegeforen. 2001, 121: 2364-7.PubMed
20.
go back to reference Uleberg O, Vinjevoll OP, Eriksson U, Aadahl P, Skogvoll E: Overtriage in trauma - what are the causes?. Acta Anaesthesiol Scand. 2007, 51: 1178-1183.PubMed Uleberg O, Vinjevoll OP, Eriksson U, Aadahl P, Skogvoll E: Overtriage in trauma - what are the causes?. Acta Anaesthesiol Scand. 2007, 51: 1178-1183.PubMed
21.
go back to reference Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ: Trauma score. Crit Care Med. 1981, 9: 672-6. 10.1097/00003246-198109000-00015.CrossRefPubMed Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ: Trauma score. Crit Care Med. 1981, 9: 672-6. 10.1097/00003246-198109000-00015.CrossRefPubMed
22.
go back to reference Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME: A revision of the Trauma Score. J Trauma. 1989, 29: 623-9. 10.1097/00005373-198905000-00017.CrossRefPubMed Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME: A revision of the Trauma Score. J Trauma. 1989, 29: 623-9. 10.1097/00005373-198905000-00017.CrossRefPubMed
23.
go back to reference Isaksen MI, Wisborg T, Brattebo G: Organization of trauma services - major improvements over four years. Tidsskr Nor Laegeforen. 2006, 126: 145-7.PubMed Isaksen MI, Wisborg T, Brattebo G: Organization of trauma services - major improvements over four years. Tidsskr Nor Laegeforen. 2006, 126: 145-7.PubMed
24.
go back to reference Esposito TJ, Offner PJ, Jurkovich GJ, Griffith J, Maier RV: Do prehospital trauma center triage criteria identify major trauma victims?. Arch Surg. 1995, 130: 171-6.CrossRefPubMed Esposito TJ, Offner PJ, Jurkovich GJ, Griffith J, Maier RV: Do prehospital trauma center triage criteria identify major trauma victims?. Arch Surg. 1995, 130: 171-6.CrossRefPubMed
25.
go back to reference Kohn MA, Hammel JM, Bretz SW, Stangby A: Trauma team activation criteria as predictors of patient disposition from the emergency department. Acad Emerg Med. 2004, 11: 1-9. 10.1111/j.1553-2712.2004.tb01364.x.CrossRefPubMed Kohn MA, Hammel JM, Bretz SW, Stangby A: Trauma team activation criteria as predictors of patient disposition from the emergency department. Acad Emerg Med. 2004, 11: 1-9. 10.1111/j.1553-2712.2004.tb01364.x.CrossRefPubMed
26.
go back to reference Boyle MJ, Smith EC, Archer F: Is mechanism of injury alone a useful predictor of major trauma?. Injury. 2008, 39: 986-92. 10.1016/j.injury.2008.03.015.CrossRefPubMed Boyle MJ, Smith EC, Archer F: Is mechanism of injury alone a useful predictor of major trauma?. Injury. 2008, 39: 986-92. 10.1016/j.injury.2008.03.015.CrossRefPubMed
27.
go back to reference 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 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
28.
go back to reference Cooper ME, Yarbrough DR, Zone-Smith L, Byrne TK, Norcross ED: Application of field triage guidelines by pre-hospital personnel: is mechanism of injury a valid guideline for patient triage?. Am Surg. 1995, 61: 363-7.PubMed Cooper ME, Yarbrough DR, Zone-Smith L, Byrne TK, Norcross ED: Application of field triage guidelines by pre-hospital personnel: is mechanism of injury a valid guideline for patient triage?. Am Surg. 1995, 61: 363-7.PubMed
29.
go back to reference Purtill MA, Benedict K, Hernandez-Boussard T, Brundage SI, Kritayakirana K, Sherck JP, Garland A, Spain DA: Validation of a prehospital trauma triage tool: A 10-year perspective. J Trauma. 2008, 65: 1253-7. 10.1097/TA.0b013e31818bbfc2.CrossRefPubMed Purtill MA, Benedict K, Hernandez-Boussard T, Brundage SI, Kritayakirana K, Sherck JP, Garland A, Spain DA: Validation of a prehospital trauma triage tool: A 10-year perspective. J Trauma. 2008, 65: 1253-7. 10.1097/TA.0b013e31818bbfc2.CrossRefPubMed
30.
go back to reference Lehmann RK, Arthurs ZM, Cuadrado DG, Casey LE, Beekley AC, Martin MJ: Trauma team activation: simplified criteria safely reduces overtriage. Am J Surg. 2007, 193: 630-4. 10.1016/j.amjsurg.2007.01.017. discussion 4-5CrossRefPubMed Lehmann RK, Arthurs ZM, Cuadrado DG, Casey LE, Beekley AC, Martin MJ: Trauma team activation: simplified criteria safely reduces overtriage. Am J Surg. 2007, 193: 630-4. 10.1016/j.amjsurg.2007.01.017. discussion 4-5CrossRefPubMed
31.
go back to reference Cook CH, Muscarella P, Praba AC, Melvin WS, Martin LC: Reducing overtriage without compromising outcomes in trauma patients. Arch Surg. 2001, 136: 752-6. 10.1001/archsurg.136.7.752.CrossRefPubMed Cook CH, Muscarella P, Praba AC, Melvin WS, Martin LC: Reducing overtriage without compromising outcomes in trauma patients. Arch Surg. 2001, 136: 752-6. 10.1001/archsurg.136.7.752.CrossRefPubMed
32.
go back to reference Smith J, Caldwell E, Sugrue M: Difference in trauma team activation criteria between hospitals within the same region. Emerg Med Australas. 2005, 17: 480-7. 10.1111/j.1742-6723.2005.00780.x.CrossRefPubMed Smith J, Caldwell E, Sugrue M: Difference in trauma team activation criteria between hospitals within the same region. Emerg Med Australas. 2005, 17: 480-7. 10.1111/j.1742-6723.2005.00780.x.CrossRefPubMed
33.
go back to reference 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.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.PubMed
34.
go back to reference Pitchford L, Smith J: Differences in trauma team activation criteria used by hospitals in the South West Peninsula. Emerg Med J. 2007, 24: 372-3. 10.1136/emj.2007.047134.PubMedCentralCrossRefPubMed Pitchford L, Smith J: Differences in trauma team activation criteria used by hospitals in the South West Peninsula. Emerg Med J. 2007, 24: 372-3. 10.1136/emj.2007.047134.PubMedCentralCrossRefPubMed
35.
go back to reference Krueger AJ, Hesselberg N, Abrahamsen GT, Bartnes K: When should the trauma team be activated?. Tidsskr Nor Laegeforen. 2006, 126: 1335-7. Krueger AJ, Hesselberg N, Abrahamsen GT, Bartnes K: When should the trauma team be activated?. Tidsskr Nor Laegeforen. 2006, 126: 1335-7.
36.
go back to reference 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, 9 (17): 1-10.1186/1757-7241-17-1.CrossRef 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, 9 (17): 1-10.1186/1757-7241-17-1.CrossRef
37.
go back to reference Eastes LS, Norton R, Brand D, Pearson S, Mullins RJ: Outcomes of patients using a tiered trauma response protocol. J Trauma. 2001, 50: 908-13. 10.1097/00005373-200105000-00022.CrossRefPubMed Eastes LS, Norton R, Brand D, Pearson S, Mullins RJ: Outcomes of patients using a tiered trauma response protocol. J Trauma. 2001, 50: 908-13. 10.1097/00005373-200105000-00022.CrossRefPubMed
Metadata
Title
Differences in trauma team activation criteria among Norwegian hospitals
Authors
Kristin T Larsen
Oddvar Uleberg
Eirik Skogvoll
Publication date
01-12-2010
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1757-7241-18-21

Other articles of this Issue 1/2010

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2010 Go to the issue