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

摘要

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. 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. 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%. 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. NCT02165137 ; retrospectively registered 11. June 2014.