Implementation of the American College of Surgeons Committee on Trauma's Trauma Team Activation Criteria at a Level II Trauma Center Improves Under-Triage for Severely 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.

Download Full-text

Initial Approach to the Management of Multisystem Trauma

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0062 ◽

2019 ◽

pp. 397-401

Author(s):

David S. Morris

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Hospital Admissions ◽

The United States ◽

Emergency Department Visits ◽

Severely Injured ◽

Level Ii ◽

Level I ◽

Nonfatal Injuries ◽

Injured Patients

Nearly 200,000 people die of injury-related causes in the United States each year, and injury is the leading cause of death for all patients aged 1 to 44 years. Approximately 30 million people sustain nonfatal injuries each year, which results in about 29 million emergency department visits and 3 million hospital admissions. Management of severely injured patients, typically defined as having an Injury Severity Score greater than 15 is best managed in a level I or level II trauma center. Any physician who provides care for critically ill patients should have a basic familiarity with the fundamentals of trauma care.

Download Full-text

Delays in Transfer of Elderly Less-injured Trauma Patients Can Have Deadly Consequences

The American Surgeon ◽

10.1177/000313481408001130 ◽

2014 ◽

Vol 80 (11) ◽

pp. 1132-1135 ◽

Cited By ~ 4

Author(s):

Peter E. Fischer ◽

Paul D. Colavita ◽

Gregory P. Fleming ◽

Toan T. Huynh ◽

A. Britton Christmas ◽

...

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Trauma Patients ◽

Severely Injured ◽

Severely Injured Patients ◽

Local Trauma ◽

Level 1 ◽

Poor Outcomes ◽

Injured Patients ◽

Level 1 Trauma Center

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals’ length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

Download Full-text

Factors Associated With the Disposition of Severely Injured Patients Initially seen at Non–Trauma Center Emergency Departments: Disparities by Insurance Status

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2014.08.006 ◽

2014 ◽

Vol 47 (4) ◽

pp. 502-503

Author(s):

Bartholomew Paull

Keyword(s):

Emergency Departments ◽

Trauma Center ◽

Insurance Status ◽

Severely Injured ◽

Severely Injured Patients ◽

Factors Associated ◽

Injured Patients

Download Full-text

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®

10.21203/rs.3.rs-74082/v1 ◽

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.

Download Full-text

354 Predictive Value of Point-of-Care Lactate Measurement in Patients Meeting Level II and II Trauma Team Activation Criteria Who Present to the Emergency Department: A Prospective Study

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2016.08.371 ◽

2016 ◽

Vol 68 (4) ◽

pp. S136

Author(s):

J. Wentling ◽

O. Blow ◽

S.P. Krall ◽

A. McNierney ◽

K. Dewey ◽

...

Keyword(s):

Emergency Department ◽

Prospective Study ◽

Predictive Value ◽

Point Of Care ◽

Trauma Team ◽

Trauma Team Activation ◽

Lactate Measurement ◽

Level Ii ◽

A Prospective Study ◽

Activation Criteria

Download Full-text

Age and traumatic brain injury as prognostic factors for late-phase mortality in patients defined as polytrauma according to the New Berlin Definition: experiences from a level I trauma center

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03626-w ◽

2020 ◽

Author(s):

V. Weihs ◽

V. Heel ◽

M. Dedeyan ◽

N. W. Lang ◽

S. Frenzel ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Prognostic Factors ◽

Trauma Center ◽

Late Phase ◽

Severely Injured ◽

Severely Injured Patients ◽

Berlin Definition ◽

Severe Tbi ◽

Level I ◽

Injured Patients

Abstract Background The rationale of this study was to identify independent prognostic factors influencing the late-phase survival of polytraumatized patients defined according to the New Berlin Definition. Methods Retrospective data analysis on 173 consecutively polytraumatized patients treated at a level I trauma center between January 2012 and December 2015. Patients were classified into two groups: severely injured patients (ISS > 16) and polytraumatized patients (patients who met the diagnostic criteria for the New Berlin Definition). Results Polytraumatized patients showed significantly lower late-phase and overall survival rates. The presence of traumatic brain injury (TBI) and age > 55 years had a significant influence on the late-phase survival in polytraumatized patients but not in severely injured patients. Despite the percentage of severe TBI being nearly identical in both groups, severe TBI was identified as main cause of death in polytraumatized patients. Furthermore, severe TBI remains the main cause of death in polytraumatized patients > 55 years of age, whereas younger polytraumatized patients (< 55 years of age) tend to die more often due to the acute trauma. Conclusion Our results suggest that age beyond 55 years and concomitant (severe) TBI remain as most important influencing risk factor for the late-phase survival of polytraumatized patients but not in severely injured patients. Level of evidence Prognostic study, level III.

Download Full-text

The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

Journal of Clinical Medicine ◽

10.3390/jcm10081700 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1700

Author(s):

Charlie Sewalt ◽

Esmee Venema ◽

Erik van Zwet ◽

Jan van Ditshuizen ◽

Stephanie Schuit ◽

...

Keyword(s):

Hospital Mortality ◽

Trauma Center ◽

Hospital Volume ◽

Injury Severity ◽

Severely Injured ◽

Trauma Centers ◽

Severely Injured Patients ◽

Level 1 ◽

Injured Patients ◽

Level 1 Trauma Center

Centralization of trauma centers leads to a higher hospital volume of severely injured patients (Injury Severity Score (ISS) > 15), but the effect of volume on outcome remains unclear. The aim of this study was to determine the association between hospital volume of severely injured patients and in-hospital mortality in Dutch Level-1 trauma centers. A retrospective observational cohort study was performed using the Dutch trauma registry. All severely injured adults (ISS > 15) admitted to a Level-1 trauma center between 2015 and 2018 were included. The effect of hospital volume on in-hospital mortality was analyzed with random effects logistic regression models with a random intercept for Level-1 trauma center, adjusted for important demographic and injury characteristics. A total of 11,917 severely injured patients from 13 Dutch Level-1 trauma centers was included in this study. Hospital volume varied from 120 to 410 severely injured patients per year. Observed mortality rates varied between 12% and 24% per center. After case-mix correction, no statistically significant differences between low- and high-volume centers were demonstrated (adjusted odds ratio 0.97 per 50 extra patients per year, 95% Confidence Interval 0.90–1.04, p = 0.44). The variation in hospital volume of the included Level-1 trauma centers was not associated with the outcome of severely injured patients. Our results suggest that well-organized trauma centers with a similar organization of care could potentially achieve comparable outcomes.

Download Full-text

A Contemporary Analysis of the Effect of Trauma Center Verification Level on Mortality in Severe Injury

The American Surgeon ◽

10.1177/00031348211023437 ◽

2021 ◽

pp. 000313482110234

Author(s):

David S. Plurad ◽

Glenn Geesman ◽

Nicholas W. Sheets ◽

Bhani Chawla-Kondal ◽

Napatakamon Ayutyanont ◽

...

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Severely Injured ◽

Adult Age ◽

Program Participant ◽

Level Ii ◽

Level I ◽

Verification Process ◽

Injured Patients ◽

The Impact

Background Literature demonstrates increased mortality for the severely injured at a Level II vs. Level I center. Our objective is to reevaluate the impact of trauma center verification level on mortality for patients with an Injury Severity Score (ISS) > 15 utilizing more contemporary data. We hypothesize that there would be no mortality discrepancy. Study Design Utilizing the ACS Trauma Quality Program Participant Use File admission year 2017, we identified severely injured (ISS >15) adult (age >15 years) patients treated at an ACS-verified Level I or Level II center. We excluded patients who underwent interfacility transfer. Logistic regression was performed to determine adjusted associations with mortality. Results There were 63 518 patients included, where 43 680 (68.8%) were treated at a Level I center and 19 838 (31.2%) at a Level II. Male gender (70.1%) and blunt injuries (92.0%) predominated. Level I admissions had a higher mean ISS [23.8 (±8.5) vs. 22.9 (±7.8), <.001], while Level II patients were older [mean age (y) 52.3 (±21.6) vs. 48.6 (±21.0), <.001] with multiple comorbidities (37.7% vs. 34.9%, <.001). Adjusted mortality between Level I and II centers was similar (12.0% vs. 11.8%, .570). Conclusions Despite previous findings, mortality outcomes are similar for severely injured patients treated at a Level I vs. Level II center. We theorize that this relates to mandated Level II resourcing as defined by an updated American College of Surgeons verification process.

Download Full-text