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Validation of the 2022 German trauma team activation criteria: a national registry study with focus on
P Faul1, P Hagebusch2, R Lefering3
1Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt, Frankfurt am Main, Germany. Philipp.Faul@BGU-Frankfurt.de.
Background:
The 2022 revision of the German Trauma Society's (DGU) trauma team activation (TTA) criteria introduces geriatric-specific modifiers to enhance the sensitivity of risk stratification in older (elderly) trauma patients. This study evaluates the validity of these updated criteria using national registry data, with particular focus on mortality gradients across activation levels and the prognostic value of newly incorporated modifiers.
Methods:
We conducted a retrospective cohort analysis of patients aged ≥ 60 years, defined as elderly trauma patients, from the TraumaRegister DGU® (TR-DGU) between 2018 and 2023. Cases were stratified according to TTA status based on both the 2016 and 2022 DGU guidelines: high risk of severe injury (HRSI), moderate risk of severe injury (MRSI), or None (provider decision). The primary outcome was in-hospital mortality. Subgroup analyses examined the impact of pre-injury anticoagulation, systolic blood pressure (SBP) 91-100 mmHg, Glasgow Coma Scale (GCS) 13-14, and multiple serious injuries, defined as Abbreviated Injury Scale (AIS) ≥ 3 in two or more body regions.
Results:
Among 66,273 elderly trauma patients, mortality according to the 2022 criteria showed a consistent risk gradient: 20.2% (high risk of severe injury, HRSI), 9.0% (moderate risk of severe injury, MRSI), and 4.2% (None). In contrast, the 2016 criteria yielded inconsistent patterns, including higher mortality in the "None" category. New modifiers were strongly predictive of mortality: multiple serious injuries in ≥ 2 regions (16.7% vs. 6.7%), SBP 91-100 mmHg (13.1% vs. 7.3%), and GCS 13-14 (12.5% vs. 5.6%). Pre-injury anticoagulation was associated with increased mortality across all subgroups (29.3% vs. 20.3%).
Conclusion:
The 2022 TTA criteria improve the alignment between triage criteria and observed mortality risk, particularly among elderly patients. The addition of geriatric-specific modifiers enhances predictive accuracy and clinical applicability. Future work should quantify implications for overtriage and resource allocation to support evidence-based trauma system optimization.