scholarly journals LO89: Factors associated with delay in trauma team activation and impact on patient outcomes

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S58-S59
Author(s):  
R. Connolly ◽  
M. Woo ◽  
J. Lampron ◽  
J.J. Perry
Keyword(s):  
Length Of Stay ◽  
Trauma Team ◽  
Operative Management ◽  
Trauma Patients ◽  
Early Group ◽  
Emergency Physicians ◽  
Trauma Team Activation ◽  
Factors Associated ◽  
Significant Difference ◽  
Delayed Group

Introduction: Trauma code activation is initiated by emergency physicians using physiologic and anatomic criteria, mechanism of injury and patient demographic factors in conjunction with data obtained from emergency medical service personnel. This enables rapid definitive treatment of trauma patients. Our objective was to identify factors associated with delayed trauma team activation. Methods: We conducted a health records review to supplement data from a regional trauma center database. We assessed consecutive cases from the trauma database from January 2008 to March 2014 including all cases in which a trauma code was activated by an emergency physician. We defined a delay in trauma code activation as a time greater than 30 minutes from time to arrival to trauma team activation. Data were collected in Microsoft Excel and analyzed in Statistical Analysis System (SAS). We conducted univariate analysis for factors potentially influencing trauma team activation and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay and time to operative management. Results: 1020 patients were screened from which 174 patients were excluded, as they were seen directly by the trauma team. 846 patients were included for our analysis. 4.1% (35/846) of trauma codes were activated after 30 minutes. Mean age was 40.8 years in the early group versus 49.2 in the delayed group p=0.01. There was no significant difference in type of injury, injury severity or time from injury between the two groups. Patients were over 70 years in 7.6% in the early activation group vs 17.1% in the delayed group (p=0.04). 77.7% of the early group were male vs 71.4% in the delayed group (p=0.39). There was no significant difference in mortality (15.2% vs 11.4% p=0.10), median length of stay (10 days in both groups p=0.94) or median time to operative management (331 minutes vs 277 minutes p=0.52). Conclusion: Delayed activation is linked with increasing age with no clear link with increased mortality. Given the severe injuries in the delayed cohort which required activation of the trauma team further emphasis on the older trauma patient and interventions to recognize this vulnerable population should be made. When assessing elderly trauma patients emergency physicians should have a low threshold to activate trauma teams.

scholarly journals Factors associated with delay in trauma team activation and impact on patient outcomes

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 606-613 ◽  
Author(s):  
Rory Connolly ◽  
Michael Y. Woo ◽  
Jacinthe Lampron ◽  
Jeffrey J. Perry
Keyword(s):  
Length Of Stay ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Group Versus ◽  
Trauma Team ◽  
Operative Management ◽  
Trauma Team Activation ◽  
Factors Associated ◽  
Significant Difference ◽  
Delayed Group

AbstractObjectiveTrauma code activation is initiated by emergency physicians using physiological and anatomical criteria, mechanism of injury, and patient demographic factors. Our objective was to identify factors associated with delayed trauma team activation.MethodsWe assessed consecutive cases from a regional trauma database from January 2008 to March 2014. We defined a delay in trauma code activation as a time greater than 30 minutes from the time of arrival. We conducted univariate analysis for factors potentially influencing trauma team activation, and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay, and time to operative management.ResultsPatients totalling 846 were included for our analysis; 4.1% (35/846) of trauma codes were activated after 30 minutes. Mean age was 40.8 years in the early group versus 49.2 in the delayed group (p=0.01). Patients were over age 70 years in 7.6% in the early activation group versus 17.1% in the delayed group (p=0.04). There was no significant difference in sex, type of injury, injury severity, or time from injury between the two groups. There was no significant difference in mortality, median length of stay, or median time to operative management.ConclusionsDelayed activation is linked with increasing age with no clear link to increased mortality. Given the severe injuries in the delayed cohort that required activation of the trauma team, further emphasis on the older trauma patient and interventions to recognize this vulnerable population should be made.

scholarly journals Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024190 ◽  
Author(s):  
Mete Erdogan ◽  
Nelofar Kureshi ◽  
Saleema A Karim ◽  
John M Tallon ◽  
Mark Asbridge ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Trauma Team ◽  
Trauma Centre ◽  
System Level ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Trauma Team Activation ◽  
Factors Associated ◽  
Patient Level ◽  
Alcohol Testing

ObjectivesAlthough alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing.DesignRetrospective cohort study.SettingTertiary trauma centre in Halifax, Canada.Participants2306 trauma patients who required activation of the trauma team.Primary outcome measureThe primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated with testing.ResultsOverall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours, or on the weekend.ConclusionsAt this tertiary trauma centre with a policy of empirical alcohol testing for TTA patients, BAC testing rates varied significantly over the 11-year study period and distinct factors were associated with alcohol testing in TTA patients.

scholarly journals The role of trauma team activation by emergency physicians on outcomes in severe trauma patients

2014 ◽  
Vol 4 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Cheng-Hsien Wang ◽  
Kuang-Yu Hsiao ◽  
Hong-Mo Shih ◽  
Yao-Hung Tsai ◽  
I-Chuan Chen
Keyword(s):  
Trauma Team ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Trauma Team Activation

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

scholarly journals Improvement in geriatric trauma outcomes in an evolving trauma system

2019 ◽  
Vol 4 (1) ◽  
pp. e000282 ◽  
Author(s):  
Amund Hovengen Ringen ◽  
Iver Anders Gaski ◽  
Hege Rustad ◽  
Nils Oddvar Skaga ◽  
Christine Gaarder ◽  
...  
Keyword(s):  
Trauma System ◽  
Trauma Team ◽  
The Elderly ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Age Group ◽  
Trauma Team Activation ◽  
Activation Rate ◽  
Time Periods ◽  
Activation Rates

BackgroundThe elderly trauma patient has increased mortality compared with younger patients. During the last 15 years, initial treatment of severely injured patients at Oslo University Hospital Ulleval (OUHU) has changed resulting in overall improved outcomes. Whether this holds true for the elderly trauma population needs exploration and was the aim of the present study.MethodsWe performed a retrospective study of 2628 trauma patients 61 years or older admitted to OUHU during the 12-year period, 2002–2013. The population was stratified based on age (61–70 years, 71–80 years, 81 years and older) and divided into time periods: 2002–2009 (P1) and 2010–2013 (P2). Multiple logistic regression models were constructed to identify clinically relevant core variables correlated with mortality and trauma team activation rate.ResultsCrude mortality decreased from 19% in P1 to 13% in P2 (p<0.01) with an OR of 0.77 (95 %CI 0.65 to 0.91) when admitted in P2. Trauma team activation rates increased from 53% in P1 to 72% in P2 (p<0.01) with an OR of 2.16 (95% CI 1.93 to 2.41) for being met by a trauma team in P2. Mortality increased from 10% in the age group 61–70 years to 26% in the group above 80 years. Trauma team activation rates decreased from 71% in the age group 61–70 years to 50% in the age group older than 80 years. Median ISS were 17 in all three age groups and in both time periods.DiscussionDevelopment of a multidisciplinary dedicated trauma service is associated with increased trauma team activation rate as well as survival in geriatric trauma patients. As expected, mortality increased with age, although inversely related to the likelihood of being met by a trauma team. Trauma team activation should be considered for all trauma patients older than 70 years.Level of evidenceLevel IV.

A Contemporary Analysis of Delayed Diagnoses After Traumatic Injury

2020 ◽  
pp. 000313482095145
Author(s):  
Justin S. Hatchimonji ◽  
Catherine E. Sharoky ◽  
Elinore J. Kaufman ◽  
Lucy W. Ma ◽  
Anna E. Garcia Whitlock ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Trauma Team ◽  
Trauma Patients ◽  
Extremity Injury ◽  
Factors Associated ◽  
Common Category ◽  
Multivariable Regression Model ◽  
Multivariable Regression

Background Factors associated with delayed injury diagnosis (DID) have been examined, but incompletely researched. Methods We evaluated demographics, mechanism, and measures of mental status and injury severity among 10 years’ worth of adult trauma patients at our center for association with DID in a multivariable regression model. Descriptions of DID injuries were reviewed to highlight characteristics of these injuries. Results We included 13 509 patients, 89 (0.7%) of whom had a recognized DID. In regression analysis, ISS (OR 1.04 per point, 95% CI 1.02-1.06) and number of injuries (OR 1.08 per injury, 95% CI 1.04-1.11) were associated with DID. Operative patients had twice the odds of DID (OR 2.02, 95% CI 1.18-3.44). The most common category of DID was orthopedic extremity injury (22/89). Conclusion DID is associated with injury severity and operative intervention. This suggests that the presence of an injury requiring operation may distract the trauma team from additional injuries.

Early versus Delayed Amputation in the Setting of Severe Lower Extremity Trauma

2015 ◽  
Vol 81 (6) ◽  
pp. 564-568 ◽  
Author(s):  
Zachary F. Williams ◽  
Lindsay M. Bools ◽  
Ashley Adams ◽  
Thomas V. Clancy ◽  
William W. Hope
Keyword(s):  
Length Of Stay ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Lower Extremity Amputation ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Early Group ◽  
Extremity Amputation

Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital deposition, are unclear. We evaluated the timing of amputations and its effects on outcomes. We retrospectively reviewed all trauma patients undergoing lower extremity amputation from January 1,2000 through December 31, 2010 at a Level 2 trauma center. Patients undergoing early amputation (amputation within 48 hours of admission) were compared with patients undergoing late amputation (amputations >48 hours after admission). Patient demographics, injury specifics, operative characteristics, and outcomes were documented. During the 11-year study period, 43 patients had a lower extremity amputation and 21 had early amputations. The two groups were similar except for a slightly higher Mangled Extremity Severity Score in the early amputation group. Total hospital length of stay significantly differed between groups, with the late amputation group length of stay being nearly twice as long. The late amputation group had significantly more ipsilateral leg complications than the early group (77% vs 15%). There was a trend toward more prosthetic use in the early group (93%vs 57%, P = 0.07). Traumatic lower extremity injuries requiring amputation are rare at our institution (0.3% incidence). Regardless of the amputation timing, most patients were able to obtain a prosthetic. Although the late group had a longer length of hospital stay and more local limb complications, attempted limb salvage still appears to be a viable option for appropriately selected trauma patients.

scholarly journals A comparative study of designated trauma team leaders on trauma patient survival and emergency department length-of-stay

CJEM ◽  
2007 ◽  
Vol 9 (02) ◽  
pp. 105-110 ◽  
Author(s):  
Garnet E. Cummings ◽  
Damon C. Mayes
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Injury Severity ◽  
Patient Survival ◽  
Negative Impact ◽  
Trauma Team ◽  
Regression Modeling ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Trauma Severity

ABSTRACT Objectives: There is controversy over who should serve as the Trauma Team Leader (TTL) at trauma-receiving centres. This study compared survival and emergency department (ED) length-of-stay between patients cared for by 3 different groups of TTLs: surgeons, emergency physicians (EPs) on call for trauma cases and EPs on shift in the ED. Methods: We performed a retrospective cohort study involving all adult major blunt trauma patients (aged 17 and older) who were admitted to 2 level I trauma centres and who were entered into a provincial Trauma Registry between March 2000 and April 2002. The study was designed to compare the effect of TTL-type on survival and ED length-of-stay, while controlling for sex, age, and trauma severity as defined by the Injury Severity Score (ISS) and the Revised Trauma Score (RTS). Analysis was performed using linear regression modeling (for the ED lenght-of-stay outcome variable), and logistic regression modeling (for the surivial outcome variable). Results: There were 1412 patients enrolled in the study. The study population comprised 74% men and 26% women, with a mean age of 44.7 years (43.1, 46.6 and 42.8 years for surgeons, on-call EPs and on-shift EPs, respectively). The overall mean ISS was 23.2 (23.7 for surgeons, 22.9 for on-call EPs and 23.3 for on-shift EPs) and the overall average RTS was 7.6 (7.6 for surgeons, 7.6 for on-call EPs and 7.5 for on-shift EPs). The overall median ED length-of-stay was 5.3 hours (4.5, 5.3 and 5.6 hours for surgeons, on-call EPs and on-shift EPs, respectively; p = 0.07) and the overall survival was 87% (86% surgeon, 88% on-call EP, 87% on-shift EP; p = 0.08). No statistically significant relationship was found between TTL-type and ED length-of-stay (p = 0.42) or survival (p = 0.43) using multivariate modeling. Conclusion: Our results suggest that surgeons, on-call EPs, or on-shift EPs can act as the TTL without a negative impact on patient survival or ED length-of-stay.

scholarly journals Radiation Exposure From CT Scanning in the Resuscitative Phase of Trauma Care: A Level One Trauma Centre Experience

CJEM ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 617-623 ◽  
Author(s):  
Lorri Beatty ◽  
Elizabeth Furey ◽  
Cupido Daniels ◽  
Avery Berman ◽  
John M. Tallon
Keyword(s):  
Radiation Exposure ◽  
Tissue Injury ◽  
Tertiary Care ◽  
Trauma Team ◽  
Trauma Centre ◽  
Whole Body ◽  
Trauma Patients ◽  
X Rays ◽  
Imaging Data ◽  
Trauma Team Activation

AbstractObjectivesThe initial management of a trauma patient often involves imaging in the form of x-rays, computed tomography (CT) and other radiographic studies, which expose the patient to ionizing radiation, an entity known to cause tissue injury and malignancy at high doses. The purpose of this study was to use a calculation-based method to determine the radiation exposure of trauma patients undergoing trauma team activation in a Canadian tertiary-care trauma centre.MethodsA retrospective chart review was conducted using the Nova Scotia Provincial Trauma Registry. All patients age 16 years old and over who underwent trauma team activation between March 1, 2008 and March 1, 2009 were included. Patients who died prior to imaging tests were excluded. Dose reports for each CT were used to calculate a whole-body radiation dose for each patient.ResultsThere were 230 trauma team activations during the study period, of which 206 had CT imaging. Data were available for 162 patients. The mean whole-body radiation exposure for all patients was 24.4±10.3 mSv, which may correlate to one additional cancer death for every 100 trauma patients scanned.ConclusionsTrauma patients are exposed to significant amounts of radiation during their initial trauma work-up, which may increase the risk of fatal cancer. Clinicians who care for these patients must be aware of the radiation exposure, and take measures to limit radiation exposure of trauma patients.

Undertriage Despite Use of Geriatric-Specific Trauma Team Activation Guidelines

2020 ◽  
pp. 000313482095145
Author(s):  
Ram V. Anantha ◽  
Matthew D. Painter ◽  
Franck Diaz-Garelli ◽  
Andrew M. Nunn ◽  
Preston R. Miller ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Tertiary Care ◽  
Trauma Team ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Care Hospital ◽  
Severely Injured ◽  
Hemorrhage Control ◽  
Trauma Team Activation ◽  
Elderly Trauma Patients

Background Elderly trauma patients are at risk for undertriage, resulting in substantial morbidity and mortality. The objective of this study was to determine whether implementation of geriatric-specific trauma team activation (TTA) protocols appropriately identified severely-injured elderly patients. Methods This single-center retrospective study evaluated all severely injured (injury severity score [ISS] >15), geriatric (≥65 years) patients admitted to our Level 1 tertiary-care hospital between January 2014 and September 2017. Undertriage was defined as the lack of TTA despite presence of severe injuries. The primary outcome was all-cause in-hospital mortality; secondary outcomes were mortality within 48 hours of admission and urgent hemorrhage control. A multivariable logistic regression analysis was performed to identify predictors of appropriate triage in this study. Results Out of 1039 severely injured geriatric patients, 628 (61%) did not undergo TTA. Undertriaged patients were significantly older and had more comorbidities. In-hospital mortality was 5% and 31% in the undertriaged and appropriately triaged groups, respectively ( P < .0001). One percent of undertriaged patients needed urgent hemorrhage control, compared to 6% of the appropriately triaged group ( P < .0001). One percent of undertriaged patients died within 48 hours compared to 19% in the appropriately triaged group ( P < .0001). Predictors of appropriate triage include GCS, heart rate, systolic blood pressure, lactic acid, ISS, shock, and absence of dementia, stroke, or alcoholism. Discussion Geriatric-specific TTA guidelines continue to undertriage elderly trauma patients when using ISS as a metric to measure undertriage. However, undertriaged patients have much lower morbidity and mortality, suggesting the geriatric-specific TTA guidelines identify those patients at highest risk for poor outcomes.

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