Development of Context-Tailored Trauma Team Activation Criteria for Injured Patients in Cameroon

Due to high service demand, there is a critical need to rapidly identify injured patients in the greatest need of emergency trauma care resources in the Cameroon health system. We evaluated context-specific indicators of mortality to develop a triage tool for trauma team activation (TTA) in Cameroon.

Data were extracted from the 10-site Cameroon Trauma Registry between July 2022 and December 2023. Injury and care patterns were evaluated as potential predictors of hospital mortality using logistic regression. Variables associated with mortality were included in the novel Cameroon triage criteria (CTC). Receiver operating characteristics (ROC) curves compared discrimination of mortality for CTC, estimated Injury Severity Score (eISS), and a United States level 1 trauma center team activation criteria.

Of 6912 patients, there were 313 (5%) in-hospital deaths. Factors independently associated with in-hospital death included burn injury (adjusted odds ratio [aOR] = 2.62), falls in patients greater than age 60 (aOR = 2.76), moderate-to-severe head injury (aOR = 12.5), and primary survey abnormalities (aOR = 11.8). The CTC (ROC AUC = 0.76, 95% CI = 0.73-0.79) was found to have superior discrimination to the US criteria (ROC AUC = 0.70, 95% CI = 0.67-0.72) and similar discrimination to eISS (ROC AUC = 0.78, 95% CI = 0.75-0.80).

The CTC demonstrates mortality prediction using injury mechanism and primary survey data that can be obtained within minutes of arrival to identify highest risk patients in need of resources. We can prospectively validate these criteria in our 10-hospital registry network to evaluate the impact of CTC activation on trauma survival.