Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU® may significantly improve overtriage - a cross sectional study

Philipp Braken, Felix Amsler, Thomas Gross, Philipp Braken, Felix Amsler, Thomas Gross

Abstract

Background: No consensus exists in the literature on the use of uniform emergency room trauma team activation criteria (ERTTAC). Today excessive over- or undertriage rates continue to be a challenge for most trauma centres. Application of ERTTAC, published for use in the German TraumaNetwork DGU®, at a Swiss trauma centre resulted in a high overtriage rate. The aim of the investigation was to analyse the ERTTAC in detail with the intention of possible improvement.

Methods: The investigation included consecutive adult (age > 15 years) trauma patients treated at the emergency department of a level II trauma centre from 01.01.2013-31.12.2015. All data were collected prospectively. To identify over- and undertriage, patients with an Injury Severity Score (ISS) > 15 were defined as requiring specific emergency room (ER) management. ANOVA, Student's t-test and chi-square analysis were used for statistical analysis with mean values ± standard deviation.

Results: 1378 adult injured (64% male) received ER trauma team treatment (mean age 48.3 ± 21.2 years; ISS 9.7 ± 9.6) during the observation period. Of those, 326 ER patients (23.7%) were diagnosed with an ISS > 15, which proved to be an overtriage of 76.3%. 80/406 trauma patients with an ISS > 15 were not referred to the ER, resulting in an actual undertriage rate of 19.7%, mainly because the criteria list was not observed. Effectively applying ERTTAC according to the protocol in all cases would have reduced undertriage to 2.0% (8/406). The most frequent trigger for trauma team activation was injury mechanism (65%). A simulation revealed that omitting the criterion 'passenger of car or truck' (n = 326) would have prevented overtriage in 257 cases, as such lowering overtriage rate to 62.4% and at the same time increasing undertriage by only 8 cases to 7.1%.

Conclusion: Application of ERTTAC as published for TraumaNetwork DGU® resulted in a lower undertriage but higher overtriage rate than recommended by the American College of Surgeons. Omitting the criterion 'passenger of car or truck' markedly improved overtriage with only a minimal increase in undertriage.

Trial registration: NCT02165137 ; retrospectively registered 11. June 2014.

Keywords: Alarm criteria; Emergency room; Glasgow Coma Scale; Injury Severity Score; Mechanism of injury; Overtriage; Trauma team activation; TraumaNetwork DGU®; Undertriage.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the regional ethics committee (2012/008) with patients consenting to participate.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Sensitivity and specificity of ERTTA for the mechanism criterion ‘car/truck passenger’. Emergency room trauma team activation (ERTTA). Percentage of false and correct positive as well as false and correct negative classification of cases with regard to ERTTA with versus without the mechanism criterion ‘car/ truck passenger’

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