Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre

M Rehn, H M Lossius, K E Tjosevik, M Vetrhus, O Østebø, T Eken, Rogaland Trauma System Study Collaborating Group, Espen Fevang, Kjetil Søreide, Eldar Søreide, Johannes Lokøy, Pieter Oord, Carina Lavransdatter Fossåen, Pål Stokkeland, Kristian Strand, M Rehn, H M Lossius, K E Tjosevik, M Vetrhus, O Østebø, T Eken, Rogaland Trauma System Study Collaborating Group, Espen Fevang, Kjetil Søreide, Eldar Søreide, Johannes Lokøy, Pieter Oord, Carina Lavransdatter Fossåen, Pål Stokkeland, Kristian Strand

Abstract

Background: A registry-based analysis revealed imprecise informal one-tiered trauma team activation (TTA) in a primary trauma centre. A two-tiered TTA protocol was introduced and analysed to examine its impact on triage precision and resource utilization.

Methods: Interhospital transfers and patients admitted by non-healthcare personnel were excluded. Undertriage was defined as the fraction of major trauma victims (New Injury Severity Score over 15) admitted without TTA. Overtriage was the fraction of TTA without major trauma.

Results: Of 1812 patients, 768 had major trauma. Overall undertriage was reduced from 28·4 to 19·1 per cent (P < 0·001) after system revision. Overall overtriage increased from 61·5 to 71·6 per cent, whereas the mean number of skilled hours spent per overtriaged patient was reduced from 6·5 to 3·5 (P < 0·001) and the number of skilled hours spent per major trauma victim was reduced from 7·4 to 7·1 (P < 0·001). Increasing age increased risk for undertriage and decreased risk for overtriage. Falls increased risk for undertriage and decreased risk for overtriage, whereas motor vehicle-related accidents showed the opposite effects. Patients triaged to a prehospital response involving an anaesthetist had less chance of both undertriage and overtriage.

Conclusion: A two-tiered TTA protocol was associated with reduced undertriage and increased overtriage, while trauma team resource consumption was reduced.

Registration number: NCT00876564 (http://www.clinicaltrials.gov).

Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Figures

Fig. 1
Fig. 1
Relationship between patient age and triage category. Box plots depict medians and interquartile ranges; whiskers represent 10th and 90th percentiles. Note non-overlapping 95 per cent confidence intervals for medians (notches)

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