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

Abstract

The four least predictive second-tier, mechanism-related criteria added little sensitivity to the trauma team activation rule at the cost of substantially decreased specificity, and they should be modified or eliminated. The first-tier, mainly physiologic criteria were all useful in predicting the need for an immediate multidisciplinary response. If increased specificity of the first-tier criteria is desired, the first criterion to eliminate is "age > 65."

Trauma in the Geriatric Population

“…Consideration of an age threshold for trauma team activation in older patients (ie, patients ages 70 years) may mitigate late recognition of injuries that might otherwise be missed. 20 The initial evaluation of injured older adults should include attention to home medications and consideration of conditions unique to older adults. Proactive assessment for and recognition of other nontraumatic conditions unique to older adults (geriatric syndromes, common comorbidities) may preempt additional complications during hospitalization.…”

Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers

“…Some researchers have advocated the use of other severity scores [27], and others have used physiologic criteria as well as resources and interventions required during trauma patient care to identify severe injuries [28]. However, ISS is correlated with trauma patient mortality and is used by the ACS-COT as a criterion for identifying severe injury [29,30].…”

Can the car tell us who needs the trauma team after a motor vehicle crash?

“…However, recent work suggests some of these criteria, particularly in regard to motor vehicle crashes, add little to the process of correctly choosing which patients should become a ''trauma code'' (evidenced by death in the ED, admission directly to the operating room or ICU) and which may safely be seen in the normal routine of the ED. 2 What we want are readily available, on-scene data points that improve both the sensitivity and specificity of trauma team activation for victims of motor vehicle crashes who do not otherwise meet physiologic criteria. The work reported by Newgard et al 4 in this issue of Annals is a first step toward improving our understanding of the effect of mechanism in determining injury severity and upgrading our ability to accurately identify those apparently ''stable'' motor vehicle occupants who need the resources of trauma team activation.…”