Optimization of trauma care: A two-tiered inhospital trauma team response system

Karien Harmsen, Annelieke. and Giannakopoulos, Georgios. and Azijli, Kaoutar. and Biesheuvel, Tessa. and George Geeraedts, Leo. and Bloemers, Frank. (2017) Optimization of trauma care: A two-tiered inhospital trauma team response system. Archives of Trauma Research, 6 (3). pp. 15-19.

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<b>Background:</b> To improve utilization of resources and reduce overtriage, two-tiered trauma team activation (TTA) system was implemented. The system activates a complete or selective trauma team (CTT, STT). Activation is based on the mechanism of injury (MOI), prehospital vital signs and injuries. <b>Objectives:</b> The objective was to evaluate the feasibility, effectiveness and safety of the implementation of a two-tiered system and whether the triage is done according to the TTA criteria. <b>Methods:</b> A prospective observational study was performed at the emergency department (ED) of a Level I trauma center. Data were collected on TTA criteria, patient demographics, MOI, prehospital vital signs, imaging modalities and blood gas analysis in the ED and inhospital data. <b>Results:</b> In 3 months, 186 patients were presented to the trauma resuscitation room. Thirty-four patients were excluded, 152 patients were included for analysis. Median age was 48 years (range 193), 64 were males. In 73, the CTT was activated, in 27 the STT, the STT was upgraded three times. Seventy-nine patients had to be admitted, the median length of stay was 5 days (range 162). Thirty-eight patients needed Intensive Care Unit (ICU) admission; the median ICU stay was 3 days (range 133). Three patients died in the resuscitation room, in total, nine patients died. Overtriage was 29 and undertriage 7. No significant difference was found for mortality, duration of hospital admission or ICU admission across the four groups (correct activation STT, undertriage, overtriage, and correct activation CTT). <b>Conclusions:</b> This TTA system identifies those patients in need of a CTT adequately with an undertriage percentage of 7, indicative of improved care for the severely injured and a more appropriate use of resources. With this model, the overtriage is set to an acceptable percentage of 29.

Item Type: Article
Subjects: Medicine
Divisions: Archives of Trauma Research journal
Depositing User: editor . truma
Date Deposited: 17 Aug 2020 14:08
Last Modified: 17 Aug 2020 14:08
URI: http://eprints.kaums.ac.ir/id/eprint/5157

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