Prehospital Hypotension as a Valid Indicator of Trauma Team Activation

Trauma Team Activation Criteria as Predictors of Patient Disposition from the Emergency Department

“…Therefore, we recommend that ''gunshot wound to head, neck, or torso'' and ''burn [ 20% body surface area'' remain first-tier criteria. In agreement with Franklin et al, 22 we also found ''systolic blood pressure \ 90'' to be a valid criterion for first-tier trauma team activation, with 65% of the additional activations due to this criterion resulting in severe injury dispositions. In agreement with Norwood et al 44 and others, 25 we found low Glasgow Coma Scale score (GCS) to be a valid predictor of the need for specialized resources; in this study, 44.2% of additional activations due to ''GCS \ 10'' had severe injury dispositions from the ED.…”

“…Dispositions were grouped into four categories: 1) discharged from ED, left before discharge, or left against medical advice; 2) admitted to floor, admitted to telemetry, or transferred to another hospital; 3) admitted to the ICU or the operating room (OR); 4) pronounced dead in the ED. Following other studies, 4,5,7,13,[21][22][23][24][25] we defined a severe injury outcome (''appropriate'' activation) as either of the latter two disposition categories: admission to the ICU/OR or death in the ED.…”

Difference in trauma team activation criteria between hospitals within the same region

“…In one series, 50% of patients with systolic BP <90 mmHg needed operative control of haemorrhage. 15 In another, Hing et al . found that when compared with patients who were normotensive, patients with prehospital hypotension were more severely injured (injury severity score 20.5 vs 11.2, Confirmed blood pressure < 90 mmHg at any time in adults Respiratory compromise/obstruction and/or intubation Transfer patients from other units receiving blood to maintain vital signs Gunshot wounds to the abdomen, neck, or chest GCS < 8 with mechanism attributed to trauma Emergency physician's discretion P < 0.001), and were more likely to require emergency surgery (42 vs 17%, P < 0.001).…”

Part 4. Clinical Practice Guideline for Surveillance and Imaging Studies of Trauma Patients in the Trauma Bay from the Korean Society of Traumatology

“…Franklin et al [1] showed that about 50% of patients with hypotension before and after presenting to the emergency room required emergency surgery or hospitalization in the intensive care unit (ICU). In addition, Tinkoff and colleagues reported that in hypotensive patients after trauma, the overall mortality rate was 24 times higher, ICU admission was seven times higher, and emergency operations were 1.6 times more common than in normotensive patients [2].…”