Let the surgeon sleep: trauma team activation for severe hypotension.
BACKGROUND
Trauma centers must balance the need to bring the full resources of the trauma center to the sickest patients emphasizing a need for personnel resource allocation. Our level I academic trauma center changed the systolic blood pressure (SBP) requirement for trauma team activation (TTA) from 90 mm Hg to 80 mm Hg. This investigation was undertaken to determine the effects of such change.


METHODS
The hospital's trauma registry identified patients for two 18-month periods, pre and post the change in TTA criteria. Data elements included team activation level, emergency department length of stay, emergency department to operating room (OR) times, delay to OR, and Injury Severity Score.


RESULTS
Full TTA decreased as did the percentage of cases with TTA. Eleven patients were identified in the SBP <80 mm Hg group who would have had TTA before the change. All 11 had timely trauma surgery consults. No delays to OR were related to TTA. The percentage of cases with laparotomy occurring >2 hours after arrival was unchanged. One hundred ninety fewer TTA were called in an 18-month period. Inpatient mortality between the two groups was not significantly changed.


CONCLUSIONS
Changing criteria for TTA from SBP 90 mm Hg to <80 mm Hg preserves personnel without patient harm. Lowering the SBP for TTA is one method of preserving trauma surgery manpower.
Shapiro
Marc J
MJ
Department of Surgery, Stony Brook University School of Medicine and University Hospital, Stony Brook, New York 11794-8191, USA. mjshapiro@notes.cc.sunysb.edu
McCormack
Jane E
JE
Jen
James
J
D000465:Algorithms; D001794:Blood Pressure; D003422:Critical Care / Q000706:statistics & numerical data*; D004526:Efficiency; D017052:Hospital Mortality / Q000639:trends; D006785:Hospitals, University; D006801:Humans; D007022:Hypotension / Q000145:classification* / Q000401:mortality; D015601:Injury Severity Score; D007857:Leadership; D007902:Length of Stay / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000145:classification / Q000401:mortality / Q000601:surgery*; D009519:New York City; D010348:Patient Care Team / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D015996:Survival Rate; D014193:Trauma Centers; D014218:Triage; D014600:Utilization Review / Q000706:statistics & numerical data; D000078329:Workforce