Outcomes of patients using a tiered trauma response protocol

Lynn S. Eastes, Robert Norton, Dawn Brand, Slone Pearson, Richard J. Mullins

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

Objectives: This study evaluated processes of care and outcome for injured patients at a Level I trauma center who had been either treated as a full trauma team activation (FULL) or managed with a modified trauma team activation (MOD). Methods: A retrospective methodology was used to evaluate all patients entered into the regional trauma system and transported from the scene to a Level I trauma center. Patients treated during a 2-year period of exclusively FULL trauma team protocols were compared with patients managed during a subsequent 2-year period after implementation of a two-tiered response. In the later era, trauma system.patients were designated before hospital arrival as either FULL or MOD trauma team responses. An additional case-control analysis was conducted on a subset of MOD trauma team response patients who were undertriaged; that is, in retrospect, they met criteria for a FULL response. The outcomes in the case-control group were compared by X2 tests and Mann-Whitney U tests. Statistical significance was assumed for p < 0.05. Results: During the presystem period, 1,740 patients were transported as trauma system entries to Oregon Health Sciences University. During the postsystem period, 2,333 patients were transported to Oregon Health Sciences University as either MOD trauma system entries (1,272 [55%]) or as FULL trauma system entries (1,061 [45 %]). Postsystem patients had longer time intervals in the emergency department compared with presystem patients. Death rates for patients who died in the emergency department or before hospital discharge were similar. Among patients who were designated as MOD trauma system entries and were subsequently categorized as meeting FULL trauma team criteria, mortality rate was low. Conclusion: Implementation of the tiered response protocol led to a substantial change in the operational response in the emergency department. Although processes of care were nominally prolonged, adverse consequences were not identified. We concluded from this quality improvement review that implementation of a tiered response protocol was satisfactory and improved efficiency. Further work is required to improve accuracy of the categorization of trauma system patients as either MOD or FULL trauma codes.

Original languageEnglish (US)
Pages (from-to)908-913
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume50
Issue number5
DOIs
StatePublished - Jan 1 2001

Keywords

  • EMS
  • Tiered trauma response
  • Trauma systems
  • Triage criteria

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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