The Efficacy of a Two-Tiered Trauma Activation System at a Level I Trauma Center

Kouzminova, Natalia B.; Shatney, Clayton H.; Palm, Erin; McCullough, Michael; Sherck, John P.

doi:10.1097/ta.0b013e3181b57b6d

Cited by 37 publications

(33 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2 Most centers have a tiered trauma activation system which determines the level of resources brought to bear upon an injured patient. 3–5 The highest level of trauma activation allocates significant multidisciplinary resources for immediate deployment, and should be reserved for the most severely injured patients. Limited trauma activation reduces the resources mobilized for less injured patients.…”

Section: Introductionmentioning

confidence: 99%

Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level

Brown

Lerner

Sperry

et al. 2016

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

Background Trauma activation level is determined by prehospital criteria. The American College of Surgeons (ACS) recommends trauma activation criteria; however, their accuracy may be limited. Prehospital lactate has shown promise in predicting trauma center resource requirements. Our objective was to investigate the added value of incorporating prehospital lactate in an algorithm to designate trauma activation level. Methods Air medical trauma patients undergoing prehospital lactate measurement were included. Algorithms using ACS activation criteria (ACS) and ACS activation criteria plus prehospital lactate (ACS+LAC) to designate trauma activation level were compared. Test characteristics and net reclassification improvement (NRI), which evaluates reclassification of patients among risk categories with additional predictive variables, were calculated. Algorithms were compared to predict trauma center need (TCN) defined as >1unit of blood in the ED; spinal cord injury; advanced airway; thoracotomy or pericardiocentesis; ICP monitoring; emergent operative or interventional radiology procedure; or death. Results There were 6,347 patients included. Twenty-eight percent had TCN. The ACS+LAC algorithm upgraded 256 patients and downgraded 548 patients compared to the ACS algorithm. The ACS+LAC algorithm versus ACS algorithm had a NRI of 0.058 (95%CI 0.044, 0.071; p<0.01), with an event NRI of −0.5% and non-event NRI of 6.2%. When weighted to favor changes in under-triage, the ACS+LAC still had a favorable overall reclassification (wNRI 0.041; 95%CI 0.028, 0.054; p=0.01). The ACS+LAC algorithm increased PPV, NPV, and accuracy. Over-triage was reduced 7.2%, while under-triage only increased 0.7%. The area under the curve (AUC) was significantly higher for the ACS+LAC algorithm (0.79 vs. 0.76, p<0.01). Conclusions The ACS+LAC algorithm reclassified patients to more appropriate levels of trauma activation when compared to the ACS algorithm. This overall benefit is achieved by significant reduction in over-triage relative to very small increase in under-triage. In the context of trauma team activation, this trade-off may be acceptable, especially in the current healthcare environment. Level of Evidence Diagnostic study, Level IV

show abstract

Section: Introductionmentioning

confidence: 99%

Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level

Brown

Lerner

Sperry

et al. 2016

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

show abstract

“…The ACS suggests that patients with major trauma receive the highest level of resources, as defined in Table S1 5,6. An injury severity score (ISS) can be calculated to quantify the severity of patient injuries 7.…”

Section: Introductionmentioning

confidence: 99%

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

“…Intentional overtriage from the field to the trauma center may be beneficial, but it is then the responsibility of the trauma center to ensure that the most seriously injured get prompt and optimal care and the less seriously injured get cost-effective and appropriate care as well. 2 Verified trauma centers use the trauma resuscitation team concept to provide immediate care to the severely injured patient. To increase efficiency, most trauma centers use a tiered trauma resuscitation system, matching the personnel and resources of the resuscitation team to the immediacy of the patient's need for care.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

“…3Y16 Effective tiered triage should allow for (1) accurate identification of the seriously injured patient, (2) no adverse effect on morbidity or mortality of those triaged to a lower level, and (3) save cost and promote better resource utilization. 2 The goal of distributing scarce resources in a safe and cost-effective manner is achieved through the appropriate application of triage criteria for each tier of the trauma resuscitation. In May 2002, the Committee on Trauma of the American College of Surgeons mandated six triage criteria (ACS-6) for the highest level of activation for both adult and pediatric trauma centers: (1) age-specific hypotension; (2) respiratory compromise or obstruction; (3) transfer from another hospital receiving blood; (4) gunshot wound to chest, abdomen, or neck; (5) Glasgow Coma Score (GCS) e 8; and (6) reduction of GCS by 2 or more.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons

Falcone¹,

Haas²,

King³

et al. 2012

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

show abstract

The Efficacy of a Two-Tiered Trauma Activation System at a Level I Trauma Center

Abstract: A two-tiered trauma activation system identifies patients who require a full trauma team response and may result in a more effective use of trauma center resources.

Cited by 37 publications

References 17 publications

Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level

Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level

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

A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons

Contact Info

Product

Resources

About