Implementation of New Trauma Triage Criteria and Implications on Under- and Overtriage. (Traumalert)

Implementation of New Trauma Triage Criteria and Implications on Under- and Overtriage

New trauma alert criteria has been introduced in Sweden, and our aim in this study is to evaluate the outcome of the old and new trauma alert criteria in a cohort of 1.300.000 inhabitants at six hospitals regarding over- and undertriage and number of alerts initiated. The Swedish trauma registry is used to identify eligible patients.

Study Overview

• Status: Completed
• Conditions: Trauma Injury
• Intervention / Treatment: Diagnostic test: Implementation of new alert criteria

Detailed Description

The Swedish trauma registry (SweTrau) was initiated in 2011, and has up to date 40.000 registered patients. In order to evaluate trauma alert criteria implemented during 2017, we plan a prospective stepped wedge trial at six hospitals in the Uppsala/Örebro region. These hospitals register in SweTrau and all had the same alert criteria prior to the implementation of new alert criteria.

A power estimation show the need for 588 patients in each group in order to show a statistical difference between 2-5% undertriage at a 95% CI.

The including hospitals has a population base of 1.300.000 inhabitants, and the annual number of trauma alerts has been about 3.000.

The registry has information about time of trauma, initiated alerts, Injury Severity Score and mechanism of injury suitable for analysis for our hypothesis.

• Study Type: Observational
• Enrollment (Actual): 2200

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All patients subject to trauma where a trauma alert was initiated OR registered patients subject to trauma without an alert call, but with an Injury Severity Score >15.

Description

Inclusion Criteria:

- All patients registered in SweTrau at all including sites between 1 June 2016 and 1 November 2017

Exclusion Criteria:

• Patients registered due to secondary referral where the initial assessment was performed at another hospital

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Prior alert criteria; Patients who activated full, limited or no alert criteria according to the prior alert criteria	Diagnostic test: Implementation of new alert criteria; The intervention is when the prior alert criteria are replaced by the present alert criteria
Present alert criteria; Patients who activated full, limited or no alert criteria according to the present alert criteria	Diagnostic test: Implementation of new alert criteria; The intervention is when the prior alert criteria are replaced by the present alert criteria

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of alerts initiated	The total number of trauma alerts initiated in the study group	One year data with intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Analysis of over- and undertriage with the Matrix method	Analyse proportions of patients subject to a full trauma team activation who have an injury severity score <15 (overtriage). Analyse proportion of patients who do not initiate a full trauma team activation but have an injury severity score >15 (undertriage) The Matrix method is a well defined method for analysing resource allocation in trauma triage.	One year data with intervention

Collaborators and Investigators

• Sponsor: Uppsala University
• Collaborators: Uppsala-Örebro Regional Research Council
• Investigators: Study Chair: Kevin Mani, Ass prof, Uppsala University

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2016
• Primary Completion (Actual): November 1, 2017
• Study Completion (Actual): November 1, 2017

Study Registration Dates

• First Submitted: December 15, 2017
• First Submitted That Met QC Criteria: January 9, 2018
• First Posted (Actual): January 10, 2018

Study Record Updates

• Last Update Posted (Actual): January 10, 2018
• Last Update Submitted That Met QC Criteria: January 9, 2018
• Last Verified: January 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries
• Other Study ID Numbers: UppsalaUH

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No