Trauma team activation criteria in managing trauma patients at an emergency room in Thailand

Original Article

Abstract

Background

Trauma team activation (TTA) criteria were first implemented in the Emergency Department (ED) of Songklanagarind Hospital in 2009 to treat severe trauma patients.

Purpose

To determine the efficacy of the TTA criteria on the acute trauma care process in the ED and the 28-day mortality rate.

Methods

A 1-year prospective cohort study was conducted at the ED. Trauma patients who were 18 years old and over who met the TTA criteria were enrolled. Demographic data, physiologic parameters, ED length of stay (EDLOS), and the injury severity score (ISS) were recorded. Multiple logistic regression was used to determine the factors affecting 28-day mortality. Institutional review board approval was obtained from the Prince of Songkla University.

Results

A total of 80 patients (74 male and 6 female) were eligible with a mean age of 34.3 years old. Shock, penetrating torso injury, and pulse rate >120 beats per minute were the three most common criteria for trauma team consultation. At the ED, 9 patients (11.3 %) were non-survivors, 30 patients (37.5 %) needed immediate operation, and 41 patients (51.2 %) were admitted. All of the arrest patients died (p < 0.0001). The median time of EDLOS was 85 min: 68 min in the non-survivor group and 120 min in the survivor group (p = 0.028). The median ISS was 21.0 (1–75): 25.0 in the non-survivor group and 17.0 in the survivor group. When compared with pilot data prior to TTA implementation, the median time of EDLOS improved from 184 to 85 min and the 28-day mortality rate decreased from 66.7 to 46.3 %. The high ISS was a predictor of death.

Conclusion

The trauma team activation criteria improved acute trauma care in the ED which was demonstrated by the decreased EDLOS and mortality rate. A high ISS is the sole parameter predicting mortality.

Keywords

Trauma team activation criteria Emergency Department Trauma 

Notes

Acknowledgments

The author thanks the Songklanagarind Hospital trauma registry for the data, Kingkarn Waiyanak for searching of articles and retrieval, Glenn K. Shingledecker for his help in editing the manuscript, and the Faculty of Medicine, Prince of Songkla University for funding this research.

Compliance with ethical standards

The institutional ethics committee board approved this study.

Conflict of interest

Prasit Wuthisuthimethawee declares that he has no conflicts of interest.

References

  1. 1.
    Lehmann RK, Arthurs ZM, Cuadrado DG, Casey LE, Beekley AC, Martin MJ. Trauma team activation: simplified criteria safely reduces overtriage. Am J Surg. 2007;193:630–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Surgeons Committee on trauma-American College of Surgeons. Resources for optimal care of the injured patient. Chicago: American College of Surgeons; 1998.Google Scholar
  3. 3.
    Sava J, Alo K, Velmahos GC, Demetriades D. All patients with truncal gunshot wounds deserve trauma team activation. J Trauma. 2000;52:276–9.Google Scholar
  4. 4.
    Tinkoff GH, O’Connor RE. Validation of new trauma triage rules for trauma attending response to the emergency department. J Trauma. 2002;52:1153–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Norwood SH, McAuley CE, Berne JD, Vallina VL, Creath RG, McLarty J. A prehospital Glasgow Coma Scale score ≤14 accurately predicts the need for full trauma team activation and patient hospitalization after motor vehicle collisions. J Trauma. 2002;53:503–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Shapiro MJ, McCormack JE, Jen J. Let the surgeon sleep: trauma team activation for severe hypotension. J Trauma. 2008;65:1245–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Cherry RA, King TS, Carney DE, Bryant P, Cooney RN. Trauma team activation and the impact on mortality. J Trauma. 2007;63:326–30.CrossRefPubMedGoogle Scholar
  8. 8.
    Khetarpal S, Steinbrunn BS, McGonigal MD, Stafford R, Ney AL, Kalb DC, et al. Trauma faculty and trauma team activation: impact on trauma system function and patient outcome. J Trauma. 1999;47:576–81.CrossRefPubMedGoogle Scholar
  9. 9.
    Larsen KT, Uleberg O, Skogvoll E. Differences in trauma team activation criteria among Norwegian hospitals. Scand J Trauma Resusc Emerg Med. 2010;18:21. doi: 10.1186/1757-7241-18-21.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Copes WS, Champion HR, Sacco WJ, Lawnick MM, Gann DS, Gannarelli T, et al. Progress in characterizing anatomic injury. J Trauma. 1990;10:1200–7.CrossRefGoogle Scholar
  11. 11.
    Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.CrossRefPubMedGoogle Scholar
  12. 12.
    Henry MC, Hollander JE, Alicandro JM, Cassara G, O’Malley S, Thode HC Jr. Incremental benefit of individual American College of Surgeons trauma triage criteria. Acad Emerg Med. 1996;11:992–1000.CrossRefGoogle Scholar
  13. 13.
    Adedeji OA, Driscoll PA. The trauma team—a system of initial trauma care. Postgrad Med J. 1996;72:587–593.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Davis KA, Cabbad NC, Schuster KM, Kaplan LJ, Carusone C, Leary T, et al. Trauma team oversight improves efficiency of care and augments clinical and economic outcomes. J Trauma. 2008;65:1236–42.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Faculty of Medicine, Songklanagarind HospitalPrince of Songkla UniversityHat Yai, SongkhlaThailand

Personalised recommendations