Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Inclusion Criteria
2.3. Data Collection
2.4. Trauma Team Activation
2.5. Statistical Analysis
3. Results
3.1. The Study Included a Total of 3754 Patients
3.2. Actual Practice/ISS 16+ (Group 1)
3.3. Actual Practice/Appropriateness of Trauma Team Activation (Group 2)
3.4. Hypothetical Triage According Guideline Criteria/ISS 16+ (Group 3)
3.5. Guideline Recommendation/Appropriateness of TTA Criteria (Group 4)
4. Discussion
5. Limitations
6. Simplified Summary
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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High Risk for Severe Injuries |
---|
Vital Signs |
Systolic blood pressure below 90 mmHg |
GCS < 9 |
Respiratory disturbance/intubation requirement |
Obvious Injuries |
Penetrating injuries of the trunk/neck region |
Gunshot injuries of the trunk/neck region |
Fractures of more than two proximal bones |
Unstable thorax |
Unstable pelvic fracture |
Amputation injury proximal to hands/feet |
Injuries with neurological paraplegic symptoms |
Open cranial injuries |
Burn > 20% of grade > 2b |
Moderate Risk for Severe Injuries |
Trauma Mechanism |
Fall from a height of more than three meters |
Traffic accident |
Frontal impact with intrusion of more than 50–75 cm |
Speed changes of delta > 30 km/h |
Pedestrian/two-wheeler collision |
Death of an occupant |
Ejection of an occupant |
Injury Severity |
---|
Maximum Abbreviated Injury Scale (AIS) severity ≥ 4 |
Intensive care (without intermediate care) |
ICU stay > 24 h |
Mortality |
Death within 24 h |
Invasive measures (prehospital or in the trauma room) |
Cardio-pulmonary resuscitation |
Advanced airway management |
Chest tube or needle decompression |
Pericardiocentesis |
Application of a tourniquet (prehospital) |
Administration of catecholamines |
Blood transfusion |
Surgical/radiological therapeutic intervention (before ICU admission) |
Life-saving/organ-saving/extremity-saving surgery |
Radiological therapeutic intervention |
≥2 external fixators (humerus, femur, pelvis) |
Impaired vital functions (prehospital or on admission) |
Pulse oximetry (SpO2) < 90% |
Respiratory rate < 9 or >29/min |
Systolic blood pressure < 90 mmHg |
Shock index > 0.9 |
Glasgow Coma Scale (GCS) < 9 |
Drop in GCS of 2 or more points prior to admission |
Hypothermia < 35 °C |
Minor Trauma | Major Trauma | Total | |
---|---|---|---|
Full trauma team activation | a | b | a + b |
Limited or no trauma team activation | c | d | c + d |
Total | a + c | b + d | N |
TTA n = 221 (84.7%) | No TTA n = 40 (15.3%) | p-Value | |
---|---|---|---|
Age (years, SD) | 53.7 (21.8) Md 55 | 71.9 (18.1) Md 80 | <0.001 |
Male | 163 (73.8%) | 24 (60.0%) | 0.076 |
Glasgow Coma Scale ≤ 8 * | 62 (28.1%) | 1 (2.5%) | <0.001 |
Systolic blood pressure < 90 | 34 (15.4%) | 0 (0%) | 0.008 |
High risk for severe injuries | 164 (74.2%) | 8 (20.0%) | <0.001 |
Abdominal injury | 45 (20.4%) | 2 (5.0%) | 0.020 |
Spine injury | 89 (40.3%) | 4 (10.0%) | <0.001 |
Extremity injury | 116 (52.5%) | 17 (42.5%) | 0.245 |
Isolated head injury | 35 (15.8%) | 17 (42.5%) | <0.001 |
ISS | 24.6 (8.9) Md 22 | 18.4 (3.4) Md 17 | <0.001 |
ISS 16+ | 100% | 100% | --- |
Emergency surgery | 73 (33.0%) | 3 (7.5%) | 0.001 |
Admission to ICU | 184 (83.3%) | 17 (42.5%) | <0.001 |
Days in ICU | 8.2 (9.8) Md 4 | 6.4 (7.8) Md 3 | 0.309 |
Death (within 48 h) | 24 (10.0%) | 2 (5.0%) | 0.255 |
TTA n = 490 (64.1%) | No TTA n = 274 (35.9%) | p-Value | |
---|---|---|---|
Age (years, SD) | 53.3 (22.1) Md 54 | 64.3 (25.4) Md 74 | <0.001 |
Male | 343 (70.0%) | 133 (48.5%) | <0.001 |
Glasgow Coma Scale ≤ 8 * | 101 (20.6%) | 9 (3.3%) | <0.001 |
Systolic blood pressure < 90 | 51 (10.4%) | 23 (8.4%) | 0.367 |
High risk for severe injuries | 309 (63.1%) | 48 (17.5%) | <0.001 |
Abdominal injury | 65 (13.3%) | 4 (1.5%) | <0.001 |
Spine injury | 160 (32.7%) | 26 (9.5%) | <0.001 |
Extremity injury | 224 (45.7%) | 142 (51.8%) | 0.105 |
Isolated head injury | 76 (15.5%) | 30 (10.9%) | 0.080 |
Injury severity score (ISS) | 14.8 (11.1) Md 13 | 6.3 (5.8) Md 4 | <0.001 |
ISS 16+ | 212 (43.3%) | 32 (11.7%) | <0.001 |
Emergency surgery | 122 (24.9%) | 18 (6.6%) | <0.001 |
Admission to ICU | 384 (78.4%) | 76 (27.7%) | <0.001 |
Days in ICU | 6.7 (8.5) Md 3 | 5.1 (5.5) Md 3 | 0.841 |
Death (within 48 h) | 29 (5.9%) | 9 (3.3%) | 0.108 |
TTA Recommended According to Guideline n = 201 (77.0%) | TTA Not Recommended n = 60 (23.0%) | p-Value | |
---|---|---|---|
Age (years, SD) | 53.8 (24.9) Md 55 | 65.4 (22.5) Md 60 | <0.001 |
Male | 143 (71.1%) | 44 (73.3%) | 0.741 |
Glasgow Coma Scale ≤ 8 * | 58 (28.9%) | 5 (8.3%) | 0.001 |
Systolic blood pressure < 90 | 34 (16.9%) | 0 (0%) | <0.001 |
High or moderate risk for severe injuries | 100% | 0% | --- |
Abdominal injury | 41 (20.4%) | 6 (10.0%) | 0.066 |
Spine injury | 84 (41.8%) | 9 (15.0%) | <0.001 |
Extremity injury | 105 (52.2%) | 28 (46.7%) | 0.449 |
Isolated head injury | 31 (15.4%) | 21 (35.0%) | <0.001 |
Injury severity score (ISS) | 24.9 (9.1) Md 22 | 19.5 (4.5) Md 18 | <0.001 |
ISS 16+ | 100% | 100% | --- |
Emergency surgery | 68 (33.8%) | 8 (13.3%) | 0.002 |
Admission to ICU | 159 (79.1%) | 42 (70.0%) | 0.141 |
Days in ICU | 6.7 (8.5) Md 3 | 5.1 (5.5) Md 3 | 0.156 |
Death (within 48 h) | 23 (11.4%) | 3 (5.0%) | 0.144 |
Appropriateness of TTA Criteria | TTA Recommended According to Guideline n = 437 (57.2%) | TTA Not Recommended n = 327 (42.8%) | p-Value |
---|---|---|---|
Age (years, SD) | 54.3 (22.2) Md 55 | 61.3 (25.4) Md 70 | <0.001 |
Male | 299 (68.4%) | 177 (54.1%) | <0.001 |
Glasgow Coma Scale ≤ 8 * | 102 (23.3%) | 8 (2.4%) | <0.001 |
Systolic blood pressure < 90 | 70 (16.0%) | 4 (1.2%) | <0.001 |
High or moderate risk for severe injuries | 100% | 0% | --- |
Abdominal injury | 58 (13.3%) | 11 (3.4%) | <0.001 |
Spine injury | 138 (31.6%) | 48 (14.7%) | <0.001 |
Extremity injury | 210 (48.1%) | 156 (47.7%) | 0.924 |
Isolated head injury | 61 (14.0%) | 45 (13.8%) | 0.938 |
Injury severity score (ISS) | 14.9 (11.4) Md 13 | 7.4 (6.7) Md 5 | <0.001 |
ISS 16+ | 191 (43.7%) | 53 (16.2%) | <0.001 |
Emergency surgery | 110 (25.2%) | 30 (9.2%) | <0.001 |
Admission to ICU | 316 (72.3%) | 144 (44.0%) | <0.001 |
Days in ICU | 6.4 (8.5) Md 3 | 4.6 (5.9) Md 2 | 0.236 |
Death (within 48 h) | 29 (6.6%) | 9 (2.8%) | 0.015 |
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Düsing, H.; Hagebusch, P.; Baacke, M.; Bieler, D.; Caspers, M.; Clemens, V.; Fröhlich, M.; Hackenberg, L.; Hartensuer, R.; Imach, S.; et al. Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers. J. Clin. Med. 2024, 13, 1714. https://doi.org/10.3390/jcm13061714
Düsing H, Hagebusch P, Baacke M, Bieler D, Caspers M, Clemens V, Fröhlich M, Hackenberg L, Hartensuer R, Imach S, et al. Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers. Journal of Clinical Medicine. 2024; 13(6):1714. https://doi.org/10.3390/jcm13061714
Chicago/Turabian StyleDüsing, Helena, Paul Hagebusch, Markus Baacke, Dan Bieler, Michael Caspers, Valentin Clemens, Matthias Fröhlich, Lisa Hackenberg, Renè Hartensuer, Sebastian Imach, and et al. 2024. "Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers" Journal of Clinical Medicine 13, no. 6: 1714. https://doi.org/10.3390/jcm13061714
APA StyleDüsing, H., Hagebusch, P., Baacke, M., Bieler, D., Caspers, M., Clemens, V., Fröhlich, M., Hackenberg, L., Hartensuer, R., Imach, S., Jensen, K. O., Keß, A., Kleber, C., Laue, F., Lefering, R., Maslauskas, M., Matthes, G., Nohl, A., Özkurtul, O., ... on behalf of the NIS-Trauma TAcTIC Study Group. (2024). Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers. Journal of Clinical Medicine, 13(6), 1714. https://doi.org/10.3390/jcm13061714