Trauma team activation and the impact on mortality

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Critical Care

Background:

• Trauma centers utilize injury mechanism, physiology, and anatomy for trauma team activation (TTA).
• A three-tier TTA system is employed to stratify patient severity and guide resource allocation.
• The effectiveness of physiologic variables in this TTA system for predicting injury severity and mortality requires examination.

Purpose of the Study:

• To evaluate whether physiologic variables within a three-tier trauma team activation system appropriately stratify patients by injury severity.
• To determine the predictive value of specific physiologic parameters for mortality in trauma patients.
• To refine criteria for full trauma team activation in blunt injury cases.

Main Methods:

• Retrospective review of a Level I trauma center's registry for adult trauma team activations (full, partial, limited).
• Data collected included Injury Severity Score (ISS), Glasgow Coma Scale (GCS), systolic blood pressure (SBP), respiratory rate (RR), and intubation status.
• Statistical analyses included hazard ratios, Kruskal-Wallis, chi-squared, and survival analyses, excluding penetrating injuries, arrests, and transfers.

Main Results:

• Physiologic variables like SBP <90, RR >29 or <10, intubation status, and GCS <8 were associated with mortality.
• Multivariate analysis identified SBP <90 and GCS <8 as the strongest predictors of mortality.
• The three-tier TTA system identified patients with increased ISS and early mortality risk (< or =4 weeks).

Conclusions:

• Trauma team activation criteria effectively identify patients with greater ISS and early mortality.
• The impact of current TTA criteria on long-term survival may not be fully appreciated.
• Full TTA criteria for blunt injury could potentially be refined to include GCS <8, SBP <90, RR >29 or <10, and intubation status.