Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre

Rehn, Marius; Lossius, Hans Morten; Tjosevik, Kjell E; Vetrhus, Morten; Østebø, O; Eken, Torsten

doi:10.1002/bjs.7794

Cited by 53 publications

(48 citation statements)

References 41 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although the benefits of multi-tiered trauma systems have been previously identified, a significant portion of patients continue to be undertriaged, and thus, are potentially at risk for adverse outcomes 23,24. The observed undertriage rate of 9.35% at our center during the study period is higher than the ACS goal undertriage rate of ≤5% 5.…”

Section: Discussionmentioning

confidence: 67%

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

Barsi

Harris

Menaik

et al. 2016

OAEM

View full text Add to dashboard Cite

PurposeThe primary objective of this study was to determine the risk factors associated with undertriage and the risk factors for mortality among the undertriaged patients at a level I safety-net trauma center.MethodsA retrospective analysis was performed of all trauma patients who presented to a level I safety-net trauma center with an injury severity score >15 over a 2-year period (2013–2014). Univariate and multivariate regression analyses were used to determine the risk factors predictive of undertriage in major trauma patients (injury severity score >15) and of mortality in undertriaged patients.ResultsDuring the 2-year study period, 334 of 2,485 admitted trauma patients presented with major trauma and were included in our study. From the univariate analysis, variables that were found to be independently associated with mortality in undertriaged patients included intubation, Glasgow Coma Scale score, revised trauma score, and dementia. Independent risk factors that were found to be significantly associated with undertriage in severely injured trauma patients included Glasgow Coma Scale score, motor vehicle crash, falls, revised trauma score, systolic blood pressure, heart rate, intubation, and dementia. When a multivariate analysis was performed to evaluate the statistically significant risk factors, dementia was found to be significantly associated with undertriage in severely injured trauma patients.ConclusionSeverely injured trauma patients with dementia are at significant risk for undertriage. Early identification of these risk factors while triaging at a level I safety-net trauma center could translate into improved patient outcomes following severe trauma.

show abstract

Section: Discussionmentioning

confidence: 67%

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

Barsi

Harris

Menaik

et al. 2016

OAEM

View full text Add to dashboard Cite

show abstract

“…Our findings indicate that an OSISP algorithm with good predictive power can be achieved without access to telemetry data. Furthermore, the sensitivities and specificities for our model are much higher than the ones reported in Rehn et al (2012) for a trauma triage protocol in a Norwegian center. This indicates that the OSISP models developed in this study could be valuable to use in conjunction with established triage protocols such as RETTS.…”

Section: Statement Of Findingsmentioning

confidence: 52%

On scene injury severity prediction (OSISP) algorithm for car occupants

Buendia

Candefjord

Fagerlind

et al. 2015

Accident Analysis & Prevention

View full text Add to dashboard Cite

Many victims in traffic accidents do not receive optimal care due to the fact that the severity of their injuries is not realized early on. Triage protocols are based on physiological and anatomical criteria and subsequently on mechanisms of injury in order to reduce undertriage. In this study the value of accident characteristics for field triage is evaluated by developing an on scene injury severity prediction (OSISP) algorithm using only accident characteristics that are feasible to assess at the scene of accident. A multivariate logistic regression model is constructed to assess the probability of a car occupant being severely injured following a crash, based on the Swedish Traffic Accident Data Acquisition (STRADA) database. Accidents involving adult occupants for calendar years 2003-2013 included in both police and hospital records, with no missing data for any of the model variables, were included. The total number of subjects was 29128, who were involved in 22607 accidents. Partition between severe and non-severe injury was done using the Injury Severity Score (ISS) with two thresholds: ISS>8 and ISS>15. The model variables are: belt use, airbag deployment, posted speed limit, type of accident, location of accident, elderly occupant (>55 years old), sex and occupant seat position. The area under the receiver operator characteristic curve (AUC) is 0.78 and 0.83 for ISS>8 and ISS>15, respectively, as estimated by 10-fold cross-validation. Belt use is the strongest predictor followed by type of accident. Posted speed limit, age and accident location contribute substantially to increase model accuracy, whereas sex and airbag deployment contribute to a smaller extent and seat position is of limited value. These findings can be used to refine triage protocols used in Sweden and possibly other countries with similar traffic environments.

show abstract

“…A tiered approach with a reduced trauma team has proven to reduce the threshold for trauma team activation while avoiding unnecessary resource consumption [28]. Tiered trauma teams are recommended by the US National guidelines for field triage and should be considered as an improvement adjustment to accommodate the increasing number of elderly trauma victims [26].…”

Section: System Revisionsmentioning

confidence: 99%

Improving adjustments for older age in pre-hospital assessment and care

Rehn

2013

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that influence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives should be implemented. Decision-makers should make system revisions and introduce advanced point-of-care initiatives to improve outcome after trauma for the elderly.

show abstract

Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre

Cited by 53 publications

References 41 publications

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

On scene injury severity prediction (OSISP) algorithm for car occupants

Improving adjustments for older age in pre-hospital assessment and care

Contact Info

Product

Resources

About