scholarly journals Evaluation of a standardized instrument for post hoc analysis of trauma-team-activation-criteria in 75,613 injured patients an analysis of the TraumaRegister DGU®

2021 ◽  
Author(s):  
Dan Bieler ◽  
◽  
Heiko Trentzsch ◽  
Axel Franke ◽  
Markus Baacke ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity ◽  
Trauma Team ◽  
Trauma Team Activation ◽  
Post Hoc Analysis ◽  
Field Triage ◽  
Severity Of Injury ◽  
Post Hoc ◽  
Injured Patients

Abstract Introduction To improve the quality of criteria for trauma-team-activation it is necessary to identify patients who benefited from the treatment by a trauma team. Therefore, we evaluated a post hoc criteria catalogue for trauma-team-activation which was developed in a consensus process by an expert group and published recently. The objective was to examine whether the catalogue can identify patients that died after admission to the hospital and therefore can benefit from a specialized trauma team mostly. Materials and methods The catalogue was applied to the data of 75,613 patients from the TraumaRegister DGU® between the 01/2007 and 12/2016 with a maximum abbreviated injury score (AIS) severity ≥ 2. The endpoint was hospital mortality, which was defined as death before discharge from acute care. Results The TraumaRegister DGU® dataset contains 18 of the 20 proposed criteria within the catalogue which identified 99.6% of the patients who were admitted to the trauma room following an accident and who died during their hospital stay. Moreover, our analysis showed that at least one criterion was fulfilled in 59,785 cases (79.1%). The average ISS in this group was 21.2 points (SD 9.9). None of the examined criteria applied to 15,828 cases (average ISS 8.6; SD 5). The number of consensus-based criteria correlated with the severity of injury and mortality. Of all deceased patients (8,451), only 31 (0.37%) could not be identified on the basis of the 18 examined criteria. Where only one criterion was fulfilled, mortality was 1.7%; with 2 or more criteria, mortality was at least 4.6%. Discussion The consensus-based criteria identified nearly all patients who died as a result of their injuries. If only one criterion was fulfilled, mortality was relatively low. However, it increased to almost 5% if two criteria were fulfilled. Further studies are necessary to analyse and examine the relative weighting of the various criteria. Summary Our instrument is capable to identify severely injured patients with increased in-hospital mortality and injury severity. However, a minimum of two criteria needs to be fulfilled. Based on these findings, we conclude that the criteria list is useful for post hoc analysis of the quality of field triage in patients with severe injury.

scholarly journals Evaluation of a Standardized Instrument for Post Hoc Analysis of Trauma-Team-Activation-Criteria in 75,613 Injured Patients - An Analysis of the TraumaRegister DGU®

2020 ◽  
Author(s):  
Dan Bieler ◽  
Heiko Trentzsch ◽  
Axel Franke ◽  
Markus Baacke ◽  
Rolf Lefering ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity ◽  
Trauma Team ◽  
Trauma Team Activation ◽  
Post Hoc Analysis ◽  
Field Triage ◽  
Severity Of Injury ◽  
Post Hoc ◽  
Injured Patients

Abstract IntroductionIn order to improve the quality of criteria for trauma-team-activation it is necessary to identify patients who benefited from the treatment by a trauma team. Therefore, we evaluated a post hoc criteria catalogue for trauma-team-activation which was developed in a consensus process by an expert group and published recently. The objective was to examine whether the catalogue can identify patients that died after admission to hospital and therefore can benefit of a specialized trauma team mostly.Materials and MethodThe catalogue was applied to the data of 75,613 patients from the TraumaRegister DGU® between the 01/2007 and 12/2016 with a maximum Abbreviated Injury Score (AIS) severity ≥ 2. The endpoint was hospital mortality, which was defined as death before discharge from acute care.ResultsThe TraumaRegister DGU® dataset contains 18 of the 20 proposed criteria within the catalogue which identified 99.6% of the patients who were admitted to the trauma room following an accident and who died during their hospital stay. Moreover, our analysis showed that at least one criterion was fulfilled in 59,785 cases (79.1%). The average ISS in this group was 21.2 points (SD 9.9). None of the examined criteria applied to 15,828 cases (average ISS 8.6; SD 5). The number of consensus-based criteria correlated with the severity of injury and mortality. Of all deceased patients (8,451), only 31 (0.37%) could not be identified on the basis of the 18 examined criteria. Where only one criterion was fulfilled, mortality was 1.7%; with 2 or more criteria, mortality was at least 4.6%.DiscussionThe consensus-based criteria identified nearly all patients who died as a result of their injuries. If only one criterion was fulfilled, mortality was relatively low. However, it increased to almost 5% if two criteria were fulfilled. Further studies are necessary to analyse and examine the relative weighting of the various criteria. SummaryOur instrument is capable to identify severely injured patients with increased in-hospital mortality and injury severity. However, a minimum of two criteria needs to be fulfilled. Based on these findings, we conclude that the criteria list is useful for post hoc analysis of the quality of field triage in patients with severe injury.

scholarly journals Evaluation of a Standardized Instrument for Post Hoc Analysis of Trauma-Team-Activation-Criteria in 75,613 Injured Patients An Analysis of the TraumaRegister DGU®

2020 ◽  
Author(s):  
Dan Bieler ◽  
Heiko Trentzsch ◽  
Axel Franke ◽  
Markus Baacke ◽  
Rolf Lefering ◽  
...  
Keyword(s):  
Trauma Team ◽  
Trauma Room ◽  
Trauma Team Activation ◽  
Severity Of Injury ◽  
Criteria Catalogue ◽  
Post Hoc ◽  
Activation Criteria ◽  
Injured Patients ◽  
Relative Weighting

Abstract IntroductionIn order to improve the quality of criteria for trauma-team-activation it is necessary to identify patients who benefited from the treatment by a trauma team. Therefore, we evaluated a post hoc criteria catalogue for trauma-team-activation which was developed in a consensus process by an expert group and published recently. The objective was to examine whether the catalogue can identify patients that died after admission to hospital and therefore can benefit of a specialized trauma team mostly.Materials and MethodThe catalogue was applied to the data of 75,613 patients from the TraumaRegister DGU® between the 01/2007 and 12/2016 with a maximum Abbreviated Injury Score (AIS) severity ≥ 2. The endpoint was hospital mortality, which was defined as death before discharge from acute care.ResultsThe TraumaRegister DGU® dataset contains 18 of the 20 proposed criteria within the catalogue which identified 99.6% of the patients who were admitted to the trauma room following an accident and who died during their hospital stay. Moreover, our analysis showed that at least one criterion was fulfilled in 59,785 cases (79.1%). The average ISS in this group was 21.2 points (SD 9.9). None of the examined criteria applied to 15,828 cases (average ISS 8.6; SD 5). The number of consensus-based criteria correlated with the severity of injury and mortality. Of all deceased patients (8,451), only 31 (0.37%) could not be identified on the basis of the 18 examined criteria. Where only one criterion was fulfilled, mortality was 1.7%; with 2 or more criteria, mortality was at least 4.6%.DiscussionThe consensus-based criteria identified nearly all patients who died as a result of their injuries. If only one criterion was fulfilled, mortality was relatively low. However, it increased to almost 5% if two criteria were fulfilled. Further studies are necessary to analyse and examine the relative weighting of the various criteria.

scholarly journals Ten-Year in-Hospital Mortality Trends among Paediatric Injured Patients in Japan: A Nationwide Observational Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3273
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Data Bank ◽  
Surveillance Systems ◽  
Mortality Trends ◽  
Nationwide Observational Study ◽  
Injured Patients

Injury is a major cause of worldwide child mortality. This retrospective nationwide study aimed to evaluate the characteristics of paediatric injured patients in Japan and their in-hospital mortality trends from 2009 to 2018. Injured patients aged <17 years were enrolled. Data were extracted from the Japan Trauma Data Bank. In the Cochran-Armitage test, in-hospital mortality significantly decreased during the study period (p < 0.001), except among patients <1 year old, and yearly reductions were observed among those with an Injury Severity Score ≥16 and survival rate ≥50% (p < 0.001). In regression analyses, patients who underwent urgent blood transfusion within 24 h after hospital admission (odds ratio (OR) = 3.24, 95% confidence interval (CI) = 2.38–4.41) had a higher in-hospital mortality risk. Higher survival probability as per the Trauma and Injury Severity Score was associated with lower in-hospital mortality (OR = 0.92, 95% CI = 0.91–0.92), a risk which decreased from 2009 to 2018 (OR = 6.16, 95% CI = 2.94–12.88). Based on our results, there is a need for improved injury surveillance systems for establishment of injury prevention strategies along with evaluation of the quality of injury care and outcome measures.

Geriatric Patients on Antithrombotic Agents who Fall: Does Trauma Team Activation Improve Outcomes?

2019 ◽  
Vol 85 (7) ◽  
pp. 721-724
Author(s):  
Peter Hwang ◽  
Adrian W. Ong ◽  
Alison Muller ◽  
Amanda Mcnicholas ◽  
Anthony Martin ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Geriatric Patients ◽  
Propensity Score Analysis ◽  
Trauma Team ◽  
The Elderly ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Trauma Team Activation ◽  
Injured Patients

Despite the incorporation of anticoagulant and antiplatelet (ACAP) drugs in our trauma triage criteria, it is unclear whether trauma team activation (TTA) impacts outcomes in geriatric patients on ACAP drugs sustaining falls. We hypothesized that TTA in this cohort was associated with improved outcomes. The hospital electronic database was queried to identify normotensive, awake patients aged ≥65 years on ACAP agent from 2014 to 2018 presenting to the emergency department after falls. The outcome was in-hospital mortality. The association between TTA and mortality was examined using logistic regression analysis and 1:1 propensity score matching analysis. In this study, 4540 patients on ACAP drugs were analyzed, with TTA occurring in 500 (11%). TTA occurred in younger but more severely injured patients with lower Glasgow Coma Score. Logistic regression revealed that TTA was not associated with mortality (odds ratio [95% confidence intervals], 2.04 [0.89–4.25]). The 1:1 propensity score analysis revealed similar mortality for the matched groups (non-TTA, 1.6% vs TTA, 2.2%, P = 0.64). In the elderly patients on ACAP agents, the current triage criteria resulted in the appropriate use of TTA for more severely injured patients. The lack of outcome benefit suggests that ACAP drug use as a criterion for TTA should be re-evaluated.

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