Trauma team activation for “mechanism of injury” blunt trauma victims: Time for a change?

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC1USC (January 2008–July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23–53]. The median Injury Severity Score was 4 [1–10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.

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Mechanism of Injury is not a Predictor of Trauma Center Admission

The American Surgeon ◽

10.1177/000313481307901116 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1149-1153 ◽

Cited By ~ 3

Author(s):

Lance E. Stuke ◽

Juan C. Duchesne ◽

John P. Hunt ◽

Alan B. Marr ◽

Peter C. Meade ◽

...

Keyword(s):

Emergency Department ◽

Trauma Center ◽

Patient Discharge ◽

Trauma Team ◽

Mechanism Of Injury ◽

Trauma Systems ◽

Trauma Team Activation ◽

Group 2 ◽

Trauma Activation ◽

Group 1

Most trauma systems use mechanism of injury (MOI) as an indicator for trauma center transport, often overburdening the system as a result of significant overtriage. Before 2005 our trauma center accepted all MOI. After 2005 we accepted only those patients meeting anatomic and physiologic (A&P) triage criteria. Patients entered into the trauma center database were divided into two groups: 2001 to 2005 (Group 1) and 2007 to 2010 (Group 2) and also categorized based on trauma team activation for either A&P or MOI criteria. Overtriage was defined as patient discharge from the emergency department within 6 hours of trauma activation. A total of 9899 patients were reviewed. Group 1 had 6584 patients with 3613 (55%) activated for A&P criteria and 2971 (45%) for MOI. Group 2 had 3315 patients with 3149 (95%) activated for A&P criteria and 166 (5%) for MOI. Accepting only those patients meeting A&P criteria resulted in a decrease in the overtriage rate from 66 to 9 per cent. By accepting only those patients meeting A&P criteria, we significantly reduced our overtriage rate. Patients meeting MOI criteria were transported to community hospitals and transferred to the trauma center if major injuries were identified. Trauma center transport for MOI results in significant overtriage and may not be justified.

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Ground-Level Geriatric Falls: A Not-So-Minor Mechanism of Injury

Case Reports in Orthopedics ◽

10.1155/2014/164632 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Simon Parker ◽

Arash Afsharpad

Keyword(s):

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Prospective Trial ◽

Significant Proportion ◽

Ground Level ◽

Trauma Team ◽

Humerus Fracture ◽

X Rays ◽

Mechanism Of Injury ◽

Trauma Team Activation

Introduction. Ground-level falls are typically regarded as a minor mechanism of injury that do not necessitate trauma team activation; however, they represent a significant proportion of hospitalised trauma and can result in multisystem injury.Case Presentation. A 79-year-old nursing home resident was brought to the emergency department following an unwitnessed fall. She suffered dementia and had a seizure in the department resulting in a reduced GCS, making history and examination difficult. She was diagnosed with a right proximal humerus fracture and admitted under joint orthopedic and medical care. Following orthopedic review, further X-rays were requested which showed bilateral neck of femur fractures. The following day she had bilateral hip hemiarthroplasties and K-wire stabilisation of the right shoulder. Several days later, when cognition had improved, she was noted to be avoiding use of the left arm and was found to also have a left proximal humerus fracture which was managed conservatively.Conclusion. Trauma patients with reduced cognitive function should undergo full ATLS assessment, and a prospective trial is required to see if age should be incorporated as a criteria for trauma team activation. More liberal use of advanced imaging such as a full body CT-scan may be beneficial.

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Mechanism of Injury Predicts Patient Mortality and Impairment After Blunt Trauma

Journal of Surgical Research ◽

10.1016/j.jss.2008.04.011 ◽

2009 ◽

Vol 153 (1) ◽

pp. 138-142 ◽

Cited By ~ 56

Author(s):

Adil H. Haider ◽

David C. Chang ◽

Elliott R. Haut ◽

Edward E. Cornwell ◽

David T. Efron

Keyword(s):

Blunt Trauma ◽

Mechanism Of Injury

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Isolated intracranial hemorrhage in elderly patients with pre-injury anticoagulation: is full trauma team activation necessary?

Journal of Surgical Research ◽

10.1016/j.jss.2021.07.021 ◽

2021 ◽

Vol 268 ◽

pp. 491-497

Author(s):

Joseph Diaz ◽

Alexandra Rooney ◽

Richard Y Calvo ◽

Derek A Benham ◽

Matthew Carr ◽

...

Keyword(s):

Elderly Patients ◽

Intracranial Hemorrhage ◽

Trauma Team ◽

Trauma Team Activation

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Let the Surgeon Sleep: Trauma Team Activation for Severe Hypotension

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31818c262f ◽

2008 ◽

Vol 65 (6) ◽

pp. 1245-1252 ◽

Cited By ~ 3

Author(s):

Marc J. Shapiro ◽

Jane E. McCormack ◽

James Jen

Keyword(s):

Trauma Team ◽

Trauma Team Activation ◽

Severe Hypotension

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LO89: Factors associated with delay in trauma team activation and impact on patient outcomes

CJEM ◽

10.1017/cem.2017.151 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S58-S59

Author(s):

R. Connolly ◽

M. Woo ◽

J. Lampron ◽

J.J. Perry

Keyword(s):

Length Of Stay ◽

Trauma Team ◽

Operative Management ◽

Trauma Patients ◽

Early Group ◽

Emergency Physicians ◽

Trauma Team Activation ◽

Factors Associated ◽

Significant Difference ◽

Delayed Group

Introduction: Trauma code activation is initiated by emergency physicians using physiologic and anatomic criteria, mechanism of injury and patient demographic factors in conjunction with data obtained from emergency medical service personnel. This enables rapid definitive treatment of trauma patients. Our objective was to identify factors associated with delayed trauma team activation. Methods: We conducted a health records review to supplement data from a regional trauma center database. We assessed consecutive cases from the trauma database from January 2008 to March 2014 including all cases in which a trauma code was activated by an emergency physician. We defined a delay in trauma code activation as a time greater than 30 minutes from time to arrival to trauma team activation. Data were collected in Microsoft Excel and analyzed in Statistical Analysis System (SAS). We conducted univariate analysis for factors potentially influencing trauma team activation and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay and time to operative management. Results: 1020 patients were screened from which 174 patients were excluded, as they were seen directly by the trauma team. 846 patients were included for our analysis. 4.1% (35/846) of trauma codes were activated after 30 minutes. Mean age was 40.8 years in the early group versus 49.2 in the delayed group p=0.01. There was no significant difference in type of injury, injury severity or time from injury between the two groups. Patients were over 70 years in 7.6% in the early activation group vs 17.1% in the delayed group (p=0.04). 77.7% of the early group were male vs 71.4% in the delayed group (p=0.39). There was no significant difference in mortality (15.2% vs 11.4% p=0.10), median length of stay (10 days in both groups p=0.94) or median time to operative management (331 minutes vs 277 minutes p=0.52). Conclusion: Delayed activation is linked with increasing age with no clear link with increased mortality. Given the severe injuries in the delayed cohort which required activation of the trauma team further emphasis on the older trauma patient and interventions to recognize this vulnerable population should be made. When assessing elderly trauma patients emergency physicians should have a low threshold to activate trauma teams.

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