The double 90 rule: A new strategy for resuscitation in non-academic level II trauma centers

Efficient resuscitation after trauma and shorter time to definitive hemorrhage control help improve trauma outcomes. We aimed to improve the speed and efficiency of resuscitation for critically ill trauma patients in the emergency department by involving interventional radiology and a second surgeon.

In 2017 our community, non-academic level II trauma center implemented the Double 90 rule-for trauma patients with 2 confirmed systolic blood pressures <90 mm Hg-which involves a second activation including the interventional radiology team, backup trauma surgeon, and operating room charge nurse. We retrospectively reviewed our trauma registry to compare data for high-level trauma patients before (2016, "Pre-Dbl90") and 3 consecutive years after intervention (2018-2020, "Dbl90").

Among 613 patients who met criteria for our highest level of trauma activation, 100 either had activation of the Double 90 rule (Dbl90 patients, n = 76) or met Double 90 rule criteria (Pre-Dbl90 patients, n = 24). The groups were similar in age, sex, injury severity score, penetrating trauma incidence, and admission vitals. Median time to computed tomography decreased throughout the study period, from 34 min in 2016 to 18 min in 2020 (P < .001). Median time to first hemorrhage control procedure decreased from 118 min (2016) to 43 min (2020), (P = .013). Mean packed red blood cell transfusion decreased from 9.1 to 4.8 units (P = .016). Mortality rates were similar between groups.

The Double 90 rule is effective for expediting trauma care starting in the emergency department, shortening the times to computed tomography, hemorrhage control intervention, and decreasing packed red blood cell transfusion.