Trauma team activation can be tailored by prehospital criteria.
A two phase prospective study was carried out at a regional Level I trauma center over 1 year. Phase I involved collecting observational data to determine which trauma criteria could potentially be used to identify patients that could be evaluated by a lower level trauma activation (category-3). A category-3 involved a smaller response team with priority access to imaging. Phase II involved implementing this third tier activation system and prospectively evaluating the outcomes related to resources and patient care. A total of 3104 patients were evaluated with 2076 patients in phase I and 1037 in phase II. Three commonly identified activation criteria out of the 36 studied were not associated with admission. These criteria were pedestrian struck by vehicle, high speed vehicular crash, and Glasgow Coma Score 12-14. These criteria were then used as triggers for a category-3 activation in phase II. Comparisons of patients with these three identified criteria between phase I and II demonstrated that significantly fewer patients were admitted, charges were reduced, emergency department times were similar, and less man-power hours were needed in phase II. The utilization of a third tiered activation system resulted in a decrease utilization of many resources without sacrificing patient care.
Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109-1998, USA. jclaridge@metrohealth.org
Jeffrey A
JA
Claridge
Joseph F
JF
Golob
William H
WH
Leukhardt
Justin A
JA
Kan
John J
JJ
Como
Mark A
MA
Malangoni
Charles J
CJ
Yowler
D000063:Accidents, Traffic; D000328:Adult; D002985:Clinical Protocols; D017598:Efficiency, Organizational; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D009820:Ohio; D011446:Prospective Studies; D014218:Triage / Q000458:organization & administration* / Q000592:standards