Delayed trauma team activation: patient characteristics and outcomes.

Abstract

BACKGROUND:

The study aimed to characterize factors linked to delayed trauma team activation (DTTA) and to establish whether these delays are linked to worse outcomes.

METHODS:

Registry data were analyzed in regard to DTTA for years 2008 to 2010 at a Level II trauma center. DTTA was defined as cases when a trauma team activation or trauma consult occurred more than 30 minutes after arrival at the emergency department in the presence of triaging criteria or clinical evidence of traumatic injury. Characteristics and outcomes were studied in relation to DTTA using contingency tables (χ test), Student's t tests, Wilcoxon statistics, and multivariate methods.

RESULTS:

DTTA occurred in 1.5% of the 9,525 patients and was significantly linked to age of 55 years or older, nonwhite ethnicity, blunt assault (i.e., struck with blunt object), Injury Severity Score of 16 or higher, Glasgow Coma Scale (GCS) score of 15, and head injury with maximum Abbreviated Injury Scale score of 3 or higher (MAIS3+). Firearm and motor vehicular injuries were significantly less common among those with DTTA. No link was found for sex, falls, stabbings, or blood alcohol concentration (BAC) of 80 mg/dL or more. Although mortality did not differ, hospital stay was longer, and discharge to rehabilitation was more common among those with DTTA. Multivariate models predicting DTTA revealed significant associations with age of more than 55 years (odds ratio [OR], 3.77 [2.54-5.53]), white ethnicity (OR, 0.47 [0.27-0.76]), blunt assault (OR, 3.42 [2.20-5.19]), and GCS score of 15 (OR, 4.48 [2.02-12.71]). Multivariate analyses did not reveal any association of DTTA with length of stay and mortality.

CONCLUSION:

DTTA occurs infrequently and is linked to older age, nonwhite ethnicity, blunt assaults, and normal GCS score. The higher rates of MAIS3+ head injuries with a maximum Abbreviated Injury Scale score of more than 3 among those with DTTA should encourage better recognition of those with these injuries.

LEVEL OF EVIDENCE:

Prognostic study, level III.

• Authors: Gabriel E Ryb, Carnell Cooper, Sandra Marie Waak
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 73 Issue 3 Pg. 695-8 (Sep 2012) ISSN: 2163-0763 [Electronic] United States
• PMID: 23007017 (Publication Type: Comparative Study, Journal Article)

Topics

• Academic Medical Centers
• Cohort Studies
• Delayed Diagnosis
• Early Diagnosis
• Emergency Service, Hospital (organization & administration)
• Emergency Treatment (methods)
• Female
• Follow-Up Studies
• Glasgow Coma Scale
• Hospital Mortality
• Humans
• Injury Severity Score
• Logistic Models
• Male
• Maryland
• Multivariate Analysis
• Patient Care Team (organization & administration)
• Proportional Hazards Models
• Registries
• Retrospective Studies
• Risk Assessment
• Survival Rate
• Time Factors
• Trauma Centers (organization & administration)
• Triage
• Wounds and Injuries (diagnosis, mortality, therapy)