title: Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma referral hospital.
abstract: OBJECTIVE
  To evaluate a two-tiered trauma activation protocol in a major trauma referral hospital in Australia.
  
  
  METHODS
  A prospective study performed over a 12-month period of all consecutive trauma activations in a major trauma referral hospital. The triage tool assigned patients into two tiers of trauma activation. The full trauma activation was initiated where physiological or anatomical criteria were present. These patients were assessed by a multispecialty trauma team. A consult trauma activation was initiated where only mechanism of injury criteria was present. These patients were assessed by the Emergency Department Registrar and Surgical Registrar. The primary endpoint was major trauma outcome defined as either injury severity score (ISS) greater than 15, requirement for High Dependency Unit or Intensive Care Unit (HDU/ICU) admission, need for urgent operative intervention, or in hospital mortality.
  
  
  RESULTS
  Of 1144 trauma activations, 468 (41%) were full trauma and 676 (59%) were consult trauma activations. The full trauma activation group had a significantly higher proportion of the major trauma outcome (34% vs. 5%, p<0.01) and all 18 patients (2%) who died were in the full trauma activation group. Sensitivity of the triage tool for the major trauma outcome was 83%, specificity was 68%, undertriage was 3% and overtriage was 27%.
  
  
  CONCLUSIONS
  The two-tiered trauma activation protocol is effective in identifying patients with major trauma from those with minor trauma. There were no deaths in undertriaged patients.
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia. davistrudi@gmail.com
authors.forename: Trudi
authors.initials: T
authors.lastname: Davis
authors.forename: Michael
authors.initials: M
authors.lastname: Dinh
authors.forename: Sue
authors.initials: S
authors.lastname: Roncal
authors.forename: Chris
authors.initials: C
authors.lastname: Byrne
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Petchell
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Leonard
authors.forename: Amanda
authors.initials: A
authors.lastname: Stack
mesh_terms: D000328:Adult; D001315:Australia; D002985:Clinical Protocols / Q000592:standards; D003422:Critical Care; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data; D015397:Program Evaluation; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration; D012680:Sensitivity and Specificity; D014193:Trauma Centers; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000145:classification* / Q000453:epidemiology