title: Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre.
abstract: BACKGROUND
  A registry-based analysis revealed imprecise informal one-tiered trauma team activation (TTA) in a primary trauma centre. A two-tiered TTA protocol was introduced and analysed to examine its impact on triage precision and resource utilization.
  
  
  METHODS
  Interhospital transfers and patients admitted by non-healthcare personnel were excluded. Undertriage was defined as the fraction of major trauma victims (New Injury Severity Score over 15) admitted without TTA. Overtriage was the fraction of TTA without major trauma.
  
  
  RESULTS
  Of 1812 patients, 768 had major trauma. Overall undertriage was reduced from 28·4 to 19·1 per cent (P < 0·001) after system revision. Overall overtriage increased from 61·5 to 71·6 per cent, whereas the mean number of skilled hours spent per overtriaged patient was reduced from 6·5 to 3·5 (P < 0·001) and the number of skilled hours spent per major trauma victim was reduced from 7·4 to 7·1 (P < 0·001). Increasing age increased risk for undertriage and decreased risk for overtriage. Falls increased risk for undertriage and decreased risk for overtriage, whereas motor vehicle-related accidents showed the opposite effects. Patients triaged to a prehospital response involving an anaesthetist had less chance of both undertriage and overtriage.
  
  
  CONCLUSIONS
  A two-tiered TTA protocol was associated with reduced undertriage and increased overtriage, while trauma team resource consumption was reduced.
  
  
  BACKGROUND
  NCT00876564 (http://www.clinicaltrials.gov).
authors.affiliation: Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway. marius.rehn@norskluftambulanse.no
authors.forename: M
authors.initials: M
authors.lastname: Rehn
authors.forename: H M
authors.initials: HM
authors.lastname: Lossius
authors.forename: K E
authors.initials: KE
authors.lastname: Tjosevik
authors.forename: M
authors.initials: M
authors.lastname: Vetrhus
authors.forename: O
authors.initials: O
authors.lastname: Østebø
authors.forename: T
authors.initials: T
authors.lastname: Eken
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000458:organization & administration; D002985:Clinical Protocols / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D011446:Prospective Studies; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration / Q000592:standards*; D000078329:Workforce; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*; D055815:Young Adult