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

Antithrombotic (anticoagulant [AC] and antiplatelet [AP]) drugs have been associated with mortality in geriatric patients with intracranial hemorrhage (ICH). It is unclear whether trauma team activation (TTA) in this cohort impacts outcome. Patients ≥65 years with a Glasgow Coma Scale of ≥13 and ICH over four years were included and were divided into three groups according to type of drug: group 1, AC with or without AP; group 2, AP only and; group 3, no AC or AP. The Rotterdam score was used to characterize the severity of CT findings. The primary outcome was inhospital mortality or transition to comfort measures. The secondary outcome was need for neurosurgical intervention within 48 hours. Logistic regression analysis was performed to evaluate for predictors of each outcome. Of 419 patients, 20.5, 50.4, and 29.1 per cent belonged to groups 1, 2, and 3, respectively, with TTA occurring in 39.5, 18.0, and 32.0 per cent of the respective groups. Within each group, there were no differences for the primary and secondary outcomes whether or not TTA was triggered. TTA patients had shorter times to CT (median, 20 minutes versus 80 minutes, P < 0.0001) and to administration of reversal agents (median, 105 minutes versus 255 minutes, P < 0.0001). Age, head-Abbreviated Injury Score, and the Rotterdam score were predictors for both outcomes by multivariable analysis, whereas antithrombotic drug use and TTA were not. In awake elderly patients on antithrombotic drugs found to have ICH, TTA expedited evaluation and treatment but was not associated with mortality benefit.

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Triage to resuscitation with trauma team activation affects outcome in elderly patients suffering severe injury

International Journal of Surgery ◽

10.1016/j.ijsu.2014.08.236 ◽

2014 ◽

Vol 12 ◽

pp. S97

Author(s):

Nabeela Malik ◽

Adam Brooks

Keyword(s):

Elderly Patients ◽

Trauma Team ◽

Severe Injury ◽

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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Paramedic Judgment of the Need for Trauma Team Activation for Pediatric Patients

Academic Emergency Medicine ◽

10.1111/j.1553-2712.1998.tb02780.x ◽

1998 ◽

Vol 5 (10) ◽

pp. 1002-1007 ◽

Cited By ~ 33

Author(s):

Khajista Qazi ◽

Jeffrey A. Kempf ◽

Norman C. Christopher ◽

Lowell W. Gerson

Keyword(s):

Pediatric Patients ◽

Trauma Team ◽

Trauma Team Activation

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Old Age as a Criterion for Trauma Team Activation

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-200110000-00022 ◽

2001 ◽

Vol 51 (4) ◽

pp. 754-757 ◽

Cited By ~ 157

Author(s):

Demetrios Demetriades ◽

Jack Sava ◽

Kathleen Alo ◽

E. Newton ◽

George C. Velmahos ◽

...

Keyword(s):

Old Age ◽

Trauma Team ◽

Trauma Team Activation

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Trauma team activation varies across Dutch emergency departments: a national survey

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-015-0185-0 ◽

2015 ◽

Vol 23 (1) ◽

Cited By ~ 4

Author(s):

Rolf E. Egberink ◽

Harm-Jan Otten ◽

Maarten J. IJzerman ◽

Arie B. van Vugt ◽

Carine J. M. Doggen

Keyword(s):

National Survey ◽

Emergency Departments ◽

Trauma Team ◽

Trauma Team Activation

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Improvement in geriatric trauma outcomes in an evolving trauma system

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000282 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000282 ◽

Cited By ~ 7

Author(s):

Amund Hovengen Ringen ◽

Iver Anders Gaski ◽

Hege Rustad ◽

Nils Oddvar Skaga ◽

Christine Gaarder ◽

...

Keyword(s):

Trauma System ◽

Trauma Team ◽

The Elderly ◽

Geriatric Trauma ◽

Trauma Patients ◽

Age Group ◽

Trauma Team Activation ◽

Activation Rate ◽

Time Periods ◽

Activation Rates

BackgroundThe elderly trauma patient has increased mortality compared with younger patients. During the last 15 years, initial treatment of severely injured patients at Oslo University Hospital Ulleval (OUHU) has changed resulting in overall improved outcomes. Whether this holds true for the elderly trauma population needs exploration and was the aim of the present study.MethodsWe performed a retrospective study of 2628 trauma patients 61 years or older admitted to OUHU during the 12-year period, 2002–2013. The population was stratified based on age (61–70 years, 71–80 years, 81 years and older) and divided into time periods: 2002–2009 (P1) and 2010–2013 (P2). Multiple logistic regression models were constructed to identify clinically relevant core variables correlated with mortality and trauma team activation rate.ResultsCrude mortality decreased from 19% in P1 to 13% in P2 (p<0.01) with an OR of 0.77 (95 %CI 0.65 to 0.91) when admitted in P2. Trauma team activation rates increased from 53% in P1 to 72% in P2 (p<0.01) with an OR of 2.16 (95% CI 1.93 to 2.41) for being met by a trauma team in P2. Mortality increased from 10% in the age group 61–70 years to 26% in the group above 80 years. Trauma team activation rates decreased from 71% in the age group 61–70 years to 50% in the age group older than 80 years. Median ISS were 17 in all three age groups and in both time periods.DiscussionDevelopment of a multidisciplinary dedicated trauma service is associated with increased trauma team activation rate as well as survival in geriatric trauma patients. As expected, mortality increased with age, although inversely related to the likelihood of being met by a trauma team. Trauma team activation should be considered for all trauma patients older than 70 years.Level of evidenceLevel IV.

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

The American Surgeon ◽

10.1177/000313481908500730 ◽

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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