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Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre

  1. M. Rehn1,2,*,
  2. H. M. Lossius1,3,
  3. K. E. Tjosevik4,
  4. M. Vetrhus5,
  5. O. Østebø4,
  6. T. Eken6,
  7. and the Rogaland Trauma System Study Collaborating Group†

Article first published online: 20 DEC 2011

DOI: 10.1002/bjs.7794

Issue

British Journal of Surgery

British Journal of Surgery

Volume 99, Issue 2, pages 199–208, February 2012

Additional Information

How to Cite

Rehn, M., Lossius, H. M., Tjosevik, K. E., Vetrhus, M., Østebø, O., Eken, T. and and the Rogaland Trauma System Study Collaborating Group (2012), Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre. Br J Surg, 99: 199–208. doi: 10.1002/bjs.7794

Author Information

  1. 1

    Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway

  2. 2

    Akershus University Hospital, Lørenskog, Norway

  3. 3

    Department of Surgical Sciences, University of Bergen, Bergen, Norway

  4. 4

    Acute Clinic, Stavanger University Hospital, Stavanger, Norway

  5. 5

    Department of Surgery, Stavanger University Hospital, Stavanger, Norway

  6. 6

    Department of Anaesthesiology, Oslo University Hospital Ullevål, Oslo, Norway

  1. †

    Members of the Rogaland Trauma System Study Collaborating Group can be found under the heading Collaborators

*Norwegian Air Ambulance Foundation, PO Box 94, 1441 Drøbak, Norway

Publication History

  1. Issue published online: 6 JAN 2012
  2. Article first published online: 20 DEC 2011
  3. Manuscript Accepted: 5 OCT 2011

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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.

Conclusion:

A two-tiered TTA protocol was associated with reduced undertriage and increased overtriage, while trauma team resource consumption was reduced. Registration number: NCT00876564 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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