Pre-Hospital Criteria Identifies Trauma Patients More Likely to be Under-Triaged to a Lower Trauma Activation Level

2018 ◽  
Vol 227 (4) ◽  
pp. e240
Author(s):  
Sawyer G. Smith ◽  
Elizabeth N. Dewey ◽  
Lynn S. Eastes ◽  
Martin A. Schreiber
Keyword(s):  
Trauma Patients ◽  
Activation Level ◽  
Trauma Activation

Radiographic Reread Protocols to Identify Clinically Relevant Errors in Initial Trauma Evaluations

2021 ◽  
pp. 000313482199867
Author(s):  
Madison E. Morgan ◽  
Catherine T. Brown ◽  
Tawnya M. Vernon ◽  
Brian W. Gross ◽  
Daniel Wu ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Radiological Imaging ◽  
Major Life ◽  
Temporal Bone Fracture ◽  
Level Ii ◽  
Activation Level ◽  
Life Threatening ◽  
Trauma Activation ◽  
Original Interpretation ◽  
Missed Diagnoses

Introduction Diagnostic radiology interpretive errors in trauma patients can lead to missed diagnoses, compromising patient care. Due to this, our level II trauma center implemented a reread protocol of all radiographic imaging within 24 hours on our highest trauma activation level (Code T). We sought to determine the efficacy of this reread protocol in identifying missed diagnoses in Code T patients. We hypothesized that a few, but clinically relevant errors, would be identified upon reread. Methods All radiographic study findings (initial read and reread) performed for Code T admissions from July 2015 to May 2016 were queried. The reviewed radiological imaging was given one of four designations: agree with interpretation, minor (non-life threatening) nonclinically relevant error(s)—addendum/correction required or clinically relevant error(s) (major [life threatening] and minor)—addendum/correction required, and trauma surgeon notified. The results were compiled, and the number of each type of error was calculated. Results Of the 752 radiological imaging studies reviewed on the 121 Code T patients during this period, 3 (0.40%) contained minor clinically relevant errors, 11 (1.46%) contained errors that were not clinically relevant, and 738 (98.1%) agreed with the original interpretation. The three clinically relevant errors included a right mandibular fracture found on X-ray and a temporal bone fracture that crossed the clivus and bilateral rib fractures found on computerized tomography. Discussion Clinically relevant errors, although minimal, were discovered during rereads for Code T patients. Although the clinical errors were significant, none affected patient outcomes. We propose that the implementation of reread protocols should be based upon institution-specific practices.

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

2020 ◽  
Vol 86 (5) ◽  
pp. 467-475
Author(s):  
Sara Seegert ◽  
Roberta E. Redfern ◽  
Bethany Chapman ◽  
Daniel Benson
Keyword(s):  
Injury Severity ◽  
Trauma Centers ◽  
Activation Level ◽  
American College Of Surgeons ◽  
Before And After ◽  
Trauma Response ◽  
Level 1 ◽  
Transferred Patients ◽  
Trauma Activation ◽  
Level 1 Trauma Center

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients

2020 ◽  
Vol 246 ◽  
pp. 153-159
Author(s):  
Jessica H. Rubens ◽  
Omar Z. Ahmed ◽  
Gayane Yenokyan ◽  
Dylan Stewart ◽  
Randall S. Burd ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Trauma Patients ◽  
Mode Of Transport ◽  
Trauma Activation ◽  
Activation Status

scholarly journals Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria

2019 ◽  
Vol Volume 11 ◽  
pp. 241-247 ◽  
Author(s):  
Forrest B Fernandez ◽  
Adrian Ong ◽  
Anthony P Martin ◽  
C William Schwab ◽  
Tom Wasser ◽  
...  
Keyword(s):  
Emergency Department ◽  
Evaluation System ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Emergency Department Triage ◽  
Trauma Activation ◽  
Activation Criteria

Evaluation of Prehospital and Emergency Department Systolic Blood Pressure as a Predictor of In-Hospital Mortality

2009 ◽  
Vol 75 (10) ◽  
pp. 1009-1014 ◽  
Author(s):  
Fariborz Lalezarzadeh ◽  
Paul Wisniewski ◽  
Katie Huynh ◽  
Maria Loza ◽  
Dev Gnanadev
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Trauma Registry ◽  
Strong Predictor ◽  
Trauma Patients ◽  
Risk Of Mortality ◽  
Blood Pressures ◽  
Activation Criterion ◽  
Trauma Activation

Hypotension is a trauma activation criterion validated by multiple studies. However, field systolic blood pressures (SBP) are still met with skepticism. How significant is the role of prehospital (PH) and emergency department (ED) SBP in the patient's overall condition? A review of the trauma registry over a 5-year period was conducted. PH SBPs were stratified into four categories: severe (SBP 80 mmHg or less), moderate (81-100 mmHg), mild hypotension (101-120 mmHg), and normotension (greater than 120 mmHg). These four groups were further subcategorized into the patients who were hypotensive, SBP 90 mmHg or less in the ED, versus those that were not (SBP greater than 90 mmHg). Data for 6964 patients were analyzed. Patients with PH SBP of 80 mmHg or less compared with patients who had PH SBP of greater than 80 mmHg had higher mortality (OR, 9; 95% CI, 6.45-12.84). Patients with both PH SBP 80 mmHg or less and ED SBP 90 mmHg or less had the highest risk of mortality (50%) and highest need for emergent operative intervention (54%). PH and ED hypotension is a strong predictor of in-hospital mortality and need for emergent surgical intervention in trauma patients. Field or ED blood pressures should serve as a significant marker of the patient's condition.

scholarly journals Increased trauma activation is not equally beneficial for all elderly trauma patients

2018 ◽  
Vol 85 (3) ◽  
pp. 598-602 ◽  
Author(s):  
Bryan W. Carr ◽  
Peter M. Hammer ◽  
Lava Timsina ◽  
Grace Rozycki ◽  
David V. Feliciano ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Trauma Activation ◽  
Elderly Trauma Patients

Location of Injury and Other Factors Associated With Increased Survival Among Severely Injured Geriatric Trauma Patients

2021 ◽  
pp. 000313482110505
Author(s):  
Paige C. Newman ◽  
Tawnya M. Vernon ◽  
Kellie E. Bresz ◽  
Jennifer A. T. Schwartz
Keyword(s):  
Geriatric Patients ◽  
Injury Severity ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Retrospective Case ◽  
Benzodiazepine Use ◽  
Trauma Outcome ◽  
Trauma Injury ◽  
Trauma Activation

Background Patients with a Trauma Injury Severity Score (TRISS) < .5 are termed “unexpected survivors.” There is scarce information published on this subset of geriatric patients whose survival is an anomaly. Methods This is a retrospective case-control study examining all geriatric patients (age ≥65) not expected to survive (TRISS<.5) in the Pennsylvania Trauma Outcome Study (PTOS) database from 2013 to 2017. Primary outcome was survival to discharge. We selected 10 clinically important variables for logistic regression analysis as possible factors that may improve survival. Results 1336 patients were included, 395 (29.6%) were unexpected survivors. Factors that improved survival odds are the following: Place of injury: street/highway (AOR:0.51; 95% CI: .36-.73, P < .001) and residential institution (AOR:0.46; 95% CI: .21-.98, P = .043); and presence of Benzodiazepines (AOR:0.49; 95% CI: .31-.77, P = .002) or ethanol (AOR:0.57; 95% CI: .34-.97, P = .040). Factors that decreased survival odds are the following: Hypotension (AOR: 8.59; 95% CI: 4.33-17.01, P < .001) and hypothermia (AOR: 1.58; 95% CI: 1.10-2.28, P = .014). Gender, race/ethnicity, blood transfusion in first 24 hours, shift of presentation to Emergency Department, place of injury (farm, industrial, recreational, or public building), use of Tetrahydrocannabinol, amphetamines or opioids, and level of trauma activation did not impact survival. Discussion Location of injury (street/highway and residential institution) and ethanol or benzodiazepine use led to a significant increased survival in severely injured geriatric patients. Hypotension and hypothermia led to decreased survival. Future studies should determine possible reasons these factors lead to survival (and identify additional factors) to focus efforts in these areas to improve outcomes in geriatric trauma.

Continued Relevance of Initial Temperature Measurement in Trauma Patients

2021 ◽  
pp. 000313482110488
Author(s):  
Jacob C. Balmer ◽  
Nathan Hieb ◽  
Brian J. Daley ◽  
Heath R. Many ◽  
Eric Heidel ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Initial Temperature ◽  
Independent Predictor ◽  
Trauma Patients ◽  
Blood Products ◽  
Patient Demographics ◽  
Icu Length Of Stay ◽  
Secondary Survey ◽  
Trauma Activation

Objectives Hypothermia occurs in 30-50% of severely injured trauma patients and is associated with multiple metabolic derangements and worsened outcomes. However, hypothermia continues to be under-diagnosed which leads to inadequate triage and treatment in trauma patients. Our study set out to determine if hypothermia is an independent predictor of mortality in trauma patients. Methods We retrospectively reviewed data of all trauma activation patients over a 5-year period. Data were collected on patient demographics, initial core temperature, Glasgow Coma Scale (GCS) on presentation, and injury severity score (ISS). Patients were then stratified into groups based on presenting temperature, ISS, and GCS. Outcomes compared were mortality, blood products received, and intensive care unit (ICU) length of stay. Correlations and logistic regression were used to test the hypotheses. Results Survival and temperature data were reviewed on 15,567 patients. Initial temperature was not significantly associated with ICU length of stay or blood products transfused ( P = .21 and P = .08, respectively). However, odds ratio of mortality in hypothermic patients (<35°C) compared to normothermic patients (35-39°C) was 3.95 (95% CI 2.90-5.41). When controlling for GCS and ISS, separately, temperature remained an independent predictor of mortality. Conclusions Hypothermia is an independent risk factor for mortality in trauma patients. It remains crucial to obtain accurate presenting temperatures in trauma patients in order to triage and treat hypothermia. Based on our data, obtaining core temperatures and rapidly treating hypothermia continues to be a vital part of the secondary survey of trauma patients.

Development of Trauma Level Prediction Models Using Emergency Medical Service Vital Signs to Reduce Over- and Undertriage Rates in Penetrating Wounds and Falls of the Elderly

2019 ◽  
Vol 85 (5) ◽  
pp. 524-529 ◽  
Author(s):  
John Cull ◽  
Robert Riggs ◽  
Sara Riggs ◽  
Megan Byham ◽  
Megan Witherspoon ◽  
...  
Keyword(s):  
Prediction Models ◽  
Vital Signs ◽  
Data Bank ◽  
Regression Equations ◽  
Binary Regression ◽  
Penetrating Wounds ◽  
National Trauma ◽  
Activation Level ◽  
National Trauma Data Bank ◽  
Trauma Activation

Determining triage activation levels in geriatric patients who fall (GF), and patients with penetrating wounds can be difficult and inaccurate, resulting in excessive overtriage (OT) and undertriage (UT) rates. We developed trauma activation prediction models using field data to predict with greater accuracy trauma activation level and triage rates consistent with the ACS recommendations. Using data from the 2014 National Trauma Data Bank, we created binary regression equations for each type of injury (GF and penetrating wounds). The 2014 data were randomized and divided into two halves. The first half for each injury type was used to generate prediction models, whereas the second half of the 2014 data were combined with 2013 and 2015 National Trauma Data Bank data for model verification. Binary regression equations were generated from vital signs collected by EMS. A Cribari grid with ISS ≥ 15 was used to determine the appropriateness of activation level. Chi-square analysis was used to determine significant differences between OT, UT, and accuracy predictions. Using our triage models, we were able to obtain UTrates of less than 4 per cent for GF with OT rates of less than 40 per cent, UT rates less than 4.1 per cent and OT of less than 50 per cent for patients with gunshot wounds, and UTrates less than 4 per cent and OT rates less than 25 per cent for patients who had stab wounds. Our developed trauma level prediction models enable health providers to predict trauma activation levels that can result in OT and UT rates in the recommended ranges by the ACS.

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