Modifying Trauma Team Activation Criteria to Increase Rates of Appropriate Triage: A Retrospective Study

The American College of Surgeons has designated six minimum criteria for a full trauma team activation, to which many Trauma Centers add criteria to reduce rates of mistriage. However, there is no consensus on what the optimal trauma team activation criteria should be. At our institution, suboptimal rates of overtriage were detected, so the trauma team activation criteria were modified to improve overtriage.

The objective was to retrospectively evaluate triage patterns before and after implementation of modified trauma team activation criteria. The hypothesis was that rates of appropriate triage and overtriage would improve following criteria modification without a significant increase in undertriaged patients.

Rates of appropriate triage, overtriage, and undertriage were assessed before and after the implementation of the modified criteria. Triage patterns were evaluated using the Standardized Trauma Assessment Tool. Statistical analyses were conducted with an alpha level of 0.05.

The modified criteria were associated with increased appropriate triage (74.7-79.4%, p < 0.01) due to a decrease in overtriage from 57.0% to 45.7% (p < 0.001). There was no change in undertriage (3.2-4.9%, p = 0.05).

This study assessed triage patterns associated with simplified, modified trauma team activation criteria at a Level 1 Trauma Center. The modified criteria were associated with decreased overtriage without increasing undertriage. These findings support simplifying trauma team activation criteria as an approach to improving rates of appropriate triage.