Elsevier

Resuscitation

Volume 73, Issue 3, June 2007, Pages 374-381
Resuscitation

Clinical paper
Do trauma teams make a difference?: A single centre registry study

https://doi.org/10.1016/j.resuscitation.2006.10.011Get rights and content

Summary

Objective

To evaluate the association between trauma team activation according to well-established protocols and patient survival.

Methods

Single centre, registry study of data collected prospectively from trauma patients (who were treated in a trauma resuscitation room, who died or who were admitted to ICU) of a tertiary referral trauma centre Emergency Department (ED) in Hong Kong. A 10-point protocol was used to activate rapid trauma team response to the ED. The main outcome measures were mortality, need for ICU care, or operation within 6 h of injury.

Results

Between 1 January 2001 and 31 December 2005, 2539 consecutive trauma patients were included in our trauma registry, of which 674 patients (mean age 43 years, S.D. 22; 71% male; 94% blunt trauma) met trauma call criteria. Four hundred and eighty two (72%) correctly triggered a trauma call, and 192 (28%) were not called (‘undercall’). Patients were less likely to have a trauma call despite meeting criteria if they were aged over 64 years, had sustained a fall, had a respiratory rate <10 or >29 per minute, a systolic blood pressure between 60 and 89 mmHg, or a GCS of 9–13. In a sub-group of moderately poor probability of survival (probability of survival, Ps, 0.5–0.75), the odds ratio for mortality in the undercall group compared with the trauma call group was 7.6 (95% CI, 1.1–33.0).

Conclusions

In our institution, undercalls account for 28% of patients who meet trauma call criteria and in patients with moderately poor probability of survival undercall is associated with decreased survival. Although trauma team activation does not guarantee better survival, better compliance with trauma team activation protocols optimises processes of care and may translate into improved survival.

Introduction

Trauma is a leading cause of death worldwide including Hong Kong1, 2 and the development of an effective trauma system is a vital strategy to optimise patient morbidity and survival.3, 4, 5 Trauma systems involve a multitude of different prehospital and hospital based components, each of which contributes in varying degrees of importance to improving patient care.6, 7, 8, 9, 10, 11, 12

When a severely injured trauma patient arrives in hospital, one important aspect of a good trauma system is the early and rapid assembly of experienced clinical decision makers who can plan and implement early life and limb saving procedures.13, 14, 15, 16, 17, 18, 19 Multiple levels for trauma team activation have been described, according to individual systems’ triage protocols, but whichever system is used, a trauma team is assembled in the trauma resuscitation room in response to a trauma activation call. Such a system has been introduced in Hong Kong since 1994.6, 20

Previous studies have shown that a good trauma system is likely to improve patient survival,6, 7, 8, 9, 10, 11, 12 that certain activation criteria may predict outcome better than others, that some absent factors should be included in trauma team protocols, e.g. age, gender, previous illness or mechanism of injury15, 17 and some report under triage and over triage rates.19 However, none have yet reported on the impact of under triage on patient survival. Does it really make a difference to patient survival if trauma calls are not activated?

The aim of this study was to evaluate the association between trauma team activation according to well-established protocols and patient survival.

Section snippets

Study design, patients and setting

This single centre, registry study of data collected prospectively was conducted on all consecutive major trauma cases included in our trauma registry database at the emergency department (ED) of the Prince of Wales Hospital (PWH) between January 2001 and December 2005. PWH is a university teaching hospital with 1200 beds and is the regional major trauma centre for the New Territories East Cluster in Hong Kong. The ED has an annual attendance of 160,000 patients per annum. Approximately 520

Statistical analysis

Baseline characteristics were analysed using the Fisher's Exact test, χ2-test, t-test, Mann–Whitney U-test, ANOVA and Kruskall–Wallis test where appropriate. In order to identify variables associated with undercall, data were initially analysed by univariate analysis. Significant ‘independent’ variables were then entered into a multiple logistic regression model with undercall as the dependent variable.

In order to determine whether undercall was associated with mortality (dependent variable),

Results

Between 1 January 2001 and 31 December 2005, 150,593 patients attended the ED with an injury. Of these, 2539 consecutive trauma patients were included in our trauma registry. After excluding a further 1865 patients who did not meet criteria for a trauma call (131 dead before arrival, 1719 patients were correct no call, and 15 patients were overcall), 674 patients remained for analysis (mean age 43 years, S.D. 22; 71% male; 94% blunt trauma), 482 (72%) were correct trauma calls, and 192 (28%)

Discussion

This study shows that in our trauma system despite protocol driven trauma call activation, there was a 28% undercall rate. Despite meeting trauma call activation criteria, trauma calls were not activated in a significant proportion of patients aged >64 years, with falls, respiratory compromise, moderate degrees of hypovolaemic shock and depressed conscious levels with GCS between 9 and 13. Patients without a trauma call were likely to undergo a mean delay of 20 min in the ED before admission to

Conflicts of interest

None.

Acknowledgements

We would like to thank all the staff working in Prince of Wales Hospital for their dedication to trauma care.

Contributors: T.R. was responsible for the original idea and is guarantor of the manuscript. All authors were involved in the overall design of the study, and modification of the manuscript. J.Y. collected data for the trauma registry. T.R., J.Y. and C.G. analysed the data. T.R. performed the statistical analysis and wrote the paper.

References (24)

  • F. Lecky et al.

    Trends in trauma care in England and Wales 1989–97. UK Trauma Audit and Research Network

    Lancet

    (2000)
  • B.R. Plaisier et al.

    Effectiveness of a 2-specialty 2-tier triage and trauma team activation protocol

    Ann Emerg Med

    (1998)
  • C.J.L. Murray et al.

    Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study

    Lancet

    (1997)
  • Department of Health HKSAR. Ten leading causes of death in Hong Kong in 2002 (ICD-10). Hong Kong, SAR;...
  • D. Demetriades et al.

    Effect of outcome of early intensive management of geriatric trauma patients

    Br J Surg

    (2002)
  • B. Celso et al.

    A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems

    J Trauma

    (2006)
  • A.O.W. Ip et al.

    Trauma service in Queen Elizabeth hospital

    Emergi-news

    (2000)
  • P.F. Lau et al.

    A brief introduction of the trauma care system in PYNEH

    Emergi-news

    (2000)
  • J.S. Young et al.

    Interhospital versus direct scene transfer of major trauma patients in a rural trauma system

    Am Surg

    (1998)
  • J.S. Sampalis et al.

    Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma

    J Trauma

    (1997)
  • P.D. Roy

    The value of trauma centres: a methodologic review

    Can J Surg

    (1987)
  • D.J. Cooper et al.

    Quality assessment of the management of road traffic fatalities at a level I trauma center compared with other hospitals in Victoria Australia. Consultative Committee on Road Traffic Fatalities in Victoria

    J Trauma

    (1998)
  • Cited by (0)

    A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2006.10.011.

    View full text