Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma referral hospital

Davis, Trudi; Dinh, Michael; Roncal, Sue; Byrne, Chris; Petchell, Jeffrey; Leonard, Elizabeth; Stack, Amanda

doi:10.1016/j.injury.2010.01.003

Cited by 72 publications

(38 citation statements)

References 16 publications

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“…This is consistent with other studies,15 16 and through continuous refinement of the trauma process and two-tier activation criteria this could be lowered further. This under-triage rate may be an overestimate, however, as 29 of these patients were admitted to ward environments for management of their injuries without further intervention in the ED, suggesting that the majority would have had their immediate needs met by the skills available within an EDTT.…”

Section: Discussionsupporting

confidence: 92%

An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre

et al. 2014

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Section: Discussionsupporting

confidence: 92%

An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre

et al. 2014

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“…Thus, the American College of Surgeons Committee on Trauma (ACS COT) has defined guidelines to guide prehospital triage to trauma centers [1]. Building on these guidelines, many centers recognize the need for two or three tiered activation criteria to more efficiently manage hospital and human resources [2-8]. Many systems including our own, require the immediate or urgent presence of attending trauma surgeons as their “highest level” response.…”

Section: Introductionmentioning

confidence: 99%

Does trauma team activation associate with the time to CT scan for those suspected of serious head injuries?

et al. 2013

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BackgroundTraumatic brain injury (TBI) constitutes the leading cause of posttraumatic mortality. Practically, the major interventions required to treat TBI predicate expedited transfer to CT after excluding other immediately life-threatening conditions. At our center, trauma responses variably consist of either full trauma activation (FTA) including an attending trauma surgeon or a non-trauma team response (NTTR). We sought to explore whether FTAs expedited the time to CT head (TTCTH).MethodsRetrospective review of augmented demographics of 88 serious head injuries identified from a Regional Trauma Registry within one year at a level I trauma center. The inclusion criteria consisted of a diagnosis of head injury recorded as intubated or GCS < 13; and CT-head scanning after arriving the emergency department. Data was analyzed using STATA.ResultsThere were 58 FTAs and 30 NTTRs; 86% of FTAs and 17% of NTTRs were intubated prehospital out of 101 charts reviewed in detail; 13 were excluded due to missing data. Although FTAs were more seriously injured (median ISS 29, MAIS head 19, GCS score at scene 6.0), NTTRs were also severely injured (median ISS 25, MAIS head 21, GCS at scene 10) and older (median 54 vs. 26 years). Median TTCTH was double without dedicated FTA (median 50 vs. 26 minutes, p < 0.001), despite similar justifiable delays (53% NTTR, 52% FTA). Without FTA, most delays (69%) were for emergency intubation. TTCTH after securing the airway was longer for NTTR group (median 38 vs. 26 minutes, p =0.0013). Even with no requirements for ED interventions, TTCTH for FTA was less than half versus NTTR (25 vs. 61 minutes, p =0.0013). Multivariate regression analysis indicated age and FTA with an attending surgeon as significant predictors of TTCTH, although the majority of variability in TTCTH was not explained by these two variables (R² = 0.33).ConclusionFull trauma activations involving attending trauma surgeons were quicker at transferring serious head injury patients to CT. Patients with FTA were younger and more seriously injured. Discerning the reasons for delays to CT should be used to refine protocols aimed at minimizing unnecessary delays and enhancing workforce efficiency and clinical outcome.

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“…Many clinical trials have investigated the correlation between various scoring systems such as Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), Trauma Score (TS), Revised Trauma Score (RTS), Modified Abbreviated Injury Severity Scale (MISS), Pediatric Trauma Score (PTS), Trauma Score Injury Severity Score (TRISS-b), A Severity Characterization of Trauma (ASCOT)-and outcome of trauma patients [4,10,21,31,35,36]. Scoring systems have their advantages, for example, in classification for research purposes, but the benefit for the single patient or the surgeon involved in the acute treatment appears limited [34].…”

Section: Introductionmentioning

confidence: 99%

CK/CK-MB ratio as an indirect predictor for survival in polytraumatized patients

Kovar

Aldrian

Endler

et al. 2012

Wien Klin Wochenschr

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Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma referral hospital

Cited by 72 publications

References 16 publications

An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre

An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre

Does trauma team activation associate with the time to CT scan for those suspected of serious head injuries?

CK/CK-MB ratio as an indirect predictor for survival in polytraumatized patients

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