Evaluation of the Sensitivity and Specificity of the Modified Moenchengladbach Resuscitation Team Activation (M²-GRETA) Criteria for Streamlined Resuscitation Room Activation at the Time of Initial Emergency Department Assessment

Background: Detailed criteria for resuscitation room activation exist for trauma and non-trauma patients in national recommendations and guidelines. By consolidation and grouping these parameters, we developed the modified Moenchengladbach Resuscitation Team Activation (M²-GRETA) criteria to create a unified and simplified activation system for both patient groups. This study evaluated the sensitivity and specificity of M²-GRETA during initial assessment in the emergency department (ED). Methods: This retrospective study (EK 24-135) included 1591 patients treated in the ED of a 754-bed teaching hospital. Patients were assigned either to the resuscitation room group (14 December 2022–28 August 2023) or the observation unit control group (1 January–4 February 2024). Exclusion criteria were age <18 yrs, inter-hospital transfers, or non-resuscitation patients requiring intensive care unit (ICU)/stroke unit admission within 24 h. Both groups were assessed for the presence of M²-GRETA criteria. Results: Mortality was higher in resuscitation patients than controls (22.5% vs. 4.8%, p < 0.001), and 62.3% required ICU transfer. In non-trauma patients, M²-GRETA showed a sensitivity of 96.3% and a specificity of 89.3%. In trauma patients, it showed a sensitivity of 87.5% and a specificity of 75.0%. Positive M²-GRETA criteria were more common in resuscitation room patients than among controls (non-trauma: 96.3% vs. 10.7%; trauma: 87.5% vs. 25.0%). The mean numbers of positive criteria in the resuscitation room groups were as follows: non-trauma 2.9 vs. 0.1; trauma 1.4 vs. 0.3; p < 0.001. Likelihood ratios (LR) indicated higher diagnostic utility in non-trauma patients (LR + 8.92; LR - 0.04) than in trauma patients (LR + 3.50; LR -0.17). Conclusion: The M²-GRETA criteria display a promising diagnostic utility in identifying patients requiring resuscitation room activation, particularly among non-trauma cases, supporting the early recognition of critically ill patients and optimized triage. Yet these preliminary results should be subject to future validation via prospective multicenter studies.