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Available from: Torsten Eken, Sep 28, 2015
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    ABSTRACT: Different criteria are employed to activate trauma teams. Because of a growing concern about overtriage, the objective of this study was to investigate the performance of our trauma team's activation protocol. Injured patients with trauma team activation (TTA), admission to an intensive care unit or surgical intermediate care unit with a trauma diagnosis, or trauma-related death in the emergency department were investigated retrospectively from 1 January 2004 to 31 December 2005. Different TTA criteria were analysed with respect to sensitivity, positive predictive value (PPV) and overtriage (1 - PPV). Eight hundred and nine patients were included, 185 (23%) of whom had an Injury Severity Score (ISS) of more than 15. The performance of our protocol showed a sensitivity of 87%, PPV of 22% and overtriage of 78%. The mechanism of injury as a TTA criterion had a sensitivity of 14%, PPV of 7% and overtriage of 93%. Physiological/anatomical criteria and interfacility transfer showed higher PPV and less overtriage. Undertriage (no TTA despite ISS > 15) was identified in 23 patients (13%), 18 of whom were hospital transfers. A TTA protocol based on physiological, anatomical and interfacility transfer criteria seems to yield a higher precision than, in particular, that based on mechanism of injury criteria. Because of substantial overtriage in our hospital, the TTA protocol needs to be re-evaluated.
    Acta Anaesthesiologica Scandinavica 11/2007; 51(9):1178-83. DOI:10.1111/j.1399-6576.2007.01414.x · 2.32 Impact Factor
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    ABSTRACT: Field triage is important for regional trauma systems providing high sensitivity to avoid that severely injured are deprived access to trauma team resuscitation (undertriage), yet high specificity to avoid resource over-utilization (overtriage). Previous informal trauma team activation (TTA) at Ulleval University Hospital (UUH) caused imprecise triage. We have analyzed triage precision after introduction of TTA guidelines. Retrospective analysis of 7 years (2001-07) of prospectively collected trauma registry data for all patients with TTA or severe injury, defined as at least one of the following: Injury Severity Score (ISS) > 15, proximal penetrating injury, admitted ICU > 2 days, transferred intubated to another hospital within 2 days, dead from trauma within 30 days. Interhospital transfers to UUH and patients admitted by non-healthcare personnel were excluded. Overtriage is the fraction of TTA where patients are not severely injured (1-positive predictive value); undertriage is the fraction of severely injured admitted without TTA (1-sensitivity). Of the 4,659 patients included in the study, 2,221 (48%) were severely injured. TTA occurred 4,440 times, only 2,002 of which for severely injured (overtriage 55%). Overall undertriage was 10%. Mechanism of injury was TTA criterion in 1,508 cases (34%), of which only 392 were severely injured (overtriage 74%). Paramedic-manned prehospital services provided 66% overtriage and 17% undertriage, anaesthetist-manned services 35% overtriage and 2% undertriage. Falls, high age and admittance by paramedics were significantly associated with undertriage. A Triage-Revised Trauma Score (RTS) < 12 in the emergency department reduced the risk for undertriage compared to RTS = 12 (normal value). Field RTS was documented by anaesthetists in 64% of the patients compared to 33% among paramedics.Patients subject to undertriage had an ISS-adjusted Odds Ratio for 30-day mortality of 2.34 (95% CI 1.6-3.4, p < 0.001) compared to those correctly triaged to TTA. Triage precision had not improved after TTA guideline introduction. Anaesthetists perform precise trauma triage, whereas paramedics have potential for improvement. Skewed mission profiles makes comparison of differences in triage precision difficult, but criteria or the use of them may contribute. Massive undertriage among paramedics is of grave concern as patients exposed to undertriage had increased risk of dying.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 02/2009; 17(1):1. DOI:10.1186/1757-7241-17-1 · 2.03 Impact Factor
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    ABSTRACT: On admission to hospital, severely injured patients should be received by a trauma team so that the prospects of early life-saving treatment are not precluded. Considerations about use of resources indicate that the team is not activated when the likelihood of serious injury is low. A recommendation with criteria for activation of the trauma team has been established at the University Hospital of North Norway. We have studied how the recommendations were followed and calculated over- and under-triage and to highlight the question of whether activation should rather be automatically implemented based on predefined criteria. We use descriptive statistics to analyse compliance with the recommendation as well as pre- and intra-hospital data for trauma patients who prior to admission were recognised as having fulfilled the criteria. Of the 109 trauma victims who, according to the recommendation, from 1 June 2001 to 31 May 2002 should have been received by the trauma team, 59 were received by a surgeon alone. Given that all patients with an injury severity score of 16 or more should be received by a trauma team, under-utilisation of the team was 50%, whereas the proportion of excess calls was 58%. Elimination of under-utilisation among this group of patients would, by strict adherence to the criteria, have conferred a very modest increase in the proportion of superfluous calls to 61%. The trauma team should be activated automatically in accordance with predefined criteria.
    Tidsskrift for den Norske laegeforening 06/2006; 126(10):1335-7.