Evaluation of a University Hospital Trauma Team Activation Protocol: a Prospective Cohort Study

1. Background Multidisciplinary trauma teams reduce mortality and have become an important part of modern trauma care. Activation of the trauma team (TTA) when receiving patients with potentially severe injuries and protocols for TTA, are widely implemented throughout Scandinavia. Trauma team activation guidelines vary somewhat among Scandinavian trauma centers, but resemble the recommendations from the American College of Surgery - Committee On Trauma (ACS-COT). The criteria are based on parameters of physiologic compromise, anatomic injury classification, and mechanism of injury (MOI). They are designed to prevent undue delay of vital care as the trauma team is activated when prehospital information indicates that at least one of the TTA criteria is fulfilled. A substantial overtriage (activation of the trauma team despite only minor or moderate injury) is common and may reach 70%, mostly reflecting the limited precision of criteria relating to MOI. Overtriage is mainly a resource problem, as assembly of the multidisciplinary trauma team diverts personnel from other important activities in the hospital. Undertriage delays diagnosis and treatment of severely injured patients and may compromise the clinical outcome and even increase mortality. ACS-COT suggests that an overtriage as high as 50% is acceptable in order to minimize undertriage.

Triage criteria should be adapted to the local case-load and injury pattern, which may vary considerably between geographical regions. The predictive properties of triage criteria depend on the prevalence of severe injuries. Typical for most Scandinavian trauma hospitals is a predominance of blunt over penetrating injuries. Furthermore, the frequency of severe polytrauma admissions is low.

In 2011, we published an evaluation of the trauma team activation protocol in our hospital, leading to a change in the criteria. This study represents an evaluation of those changes and also addresses whether there may be a potential for further improvements. 2. Aim of the study The aim of the study is to establish the predictive properties of our TTA protocol, and its individual criteria, and if possible to suggest changes that reduce over- and undertriage.

The study will also give an overview of the frequency and type of emergency procedures at a university hospital trauma center, which can contribute to optimal resource use and indicate which type of surgical skills are necessary in our trauma emergency procedures. 3. Method Identification of patients and inclusion-/exclusion criteria The trauma register at UNN Tromsø registers all patients admitted with TTA. Also included are patients with penetrating injury to the head/neck/torso/extremities proximal for elbow or knee, all patients with New Injury Severity Score (NISS) >12 and all patients with a head injury with AIS≥3. Excluded from the trauma register are patients with a chronic subdural hematoma, and patients with injuries from drowning, inhalation and asphyxia (strangulation/hanging).

From the patients in the trauma register in the time period 1.2.2013 - 31.01.2015, we will identify and include patients.