Evaluation of a standardized instrument for post hoc analysis of trauma-team-activation-criteria in 75,613 injured patients an analysis of the TraumaRegister DGU
Field triage
Severe injury
Trauma care
Trauma-team-activation
TraumaRegister DGU®
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
10
10
2020
accepted:
07
04
2021
pubmed:
21
4
2021
medline:
14
4
2022
entrez:
20
4
2021
Statut:
ppublish
Résumé
To improve the quality of criteria for trauma-team-activation it is necessary to identify patients who benefited from the treatment by a trauma team. Therefore, we evaluated a post hoc criteria catalogue for trauma-team-activation which was developed in a consensus process by an expert group and published recently. The objective was to examine whether the catalogue can identify patients that died after admission to the hospital and therefore can benefit from a specialized trauma team mostly. The catalogue was applied to the data of 75,613 patients from the TraumaRegister DGU The TraumaRegister DGU The consensus-based criteria identified nearly all patients who died as a result of their injuries. If only one criterion was fulfilled, mortality was relatively low. However, it increased to almost 5% if two criteria were fulfilled. Further studies are necessary to analyse and examine the relative weighting of the various criteria. Our instrument is capable to identify severely injured patients with increased in-hospital mortality and injury severity. However, a minimum of two criteria needs to be fulfilled. Based on these findings, we conclude that the criteria list is useful for post hoc analysis of the quality of field triage in patients with severe injury.
Identifiants
pubmed: 33876258
doi: 10.1007/s00068-021-01668-2
pii: 10.1007/s00068-021-01668-2
pmc: PMC9001544
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1101-1109Informations de copyright
© 2021. The Author(s).
Références
Kuhne CA, Ruchholtz S, Buschmann C, Sturm J, Lackner CK, Wentzensen A, Bouillon B, Waydhas C, Weber C. Trauma centers in Germany. Status report. Unfallchirurg. 2006;109(5):357–66.
doi: 10.1007/s00113-005-1049-2
Paffrath T, Lefering R, Flohe S. How to define severely injured patients?—an injury severity score (ISS) based approach alone is not sufficient. Injury. 2014;45(Suppl 3):S64-69.
doi: 10.1016/j.injury.2014.08.020
Debus F, Lefering R, Frink M, Kuhne CA, Mand C, Bucking B, Ruchholtz S. Numbers of severely injured patients in Germany. A retrospective analysis from the dgu (German Society for Trauma Surgery) trauma registry. Dtsch Arztebl Int. 2015;112(49):823–9.
pubmed: 26754119
pmcid: 4711294
Tscherne H, Regel G, Sturm JA, Friedl HP. Degree of severity and priorities in multiple injuries. Chirurg. 1987;58(10):631–40.
pubmed: 3677879
Bouillon B, Pieper D, Flohé S, Eikermann M, Prengel P, Ruchholtz S, Stürmer KM, Waydhas C, Trentzsch H, Lendemans S, et al. Level 3 guideline on the treatment of patients with severe/multiple injuries. Eur J Trauma Emerg Surg. 2018;44(Suppl 1):3–271.
Mohan D, Rosengart MR, Farris C, Cohen E, Angus DC, Barnato AE. Assessing the feasibility of the American College of Surgeons’ benchmarks for the triage of trauma patients. Arch Surg. 2011;146(7):786–92.
doi: 10.1001/archsurg.2011.43
Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, Wald MM, Jurkovich GJ, Newgard CD, Lerner EB. Guidelines for field triage of injured patients: recommendations of the national expert panel on field triage, 2011. MMWR Recomm Rep. 2012;61(1):1–20.
pubmed: 22237112
Davis JW, Dirks RC, Sue LP, Kaups KL. Attempting to validate the overtriage/undertriage matrix at a level I trauma center. J Trauma Acute Care Surg. 2017;83(6):1173–8.
doi: 10.1097/TA.0000000000001623
Lerner EB, Willenbring BD, Pirrallo RG, Brasel KJ, Cady CE, Colella MR, Cooper A, Cushman JT, Gourlay DM, Jurkovich GJ, et al. A consensus-based criterion standard for trauma center need. J Trauma Acute Care Surg. 2014;76(4):1157–63.
doi: 10.1097/TA.0000000000000189
Ciesla DJ, Pracht EE, Tepas JJ 3rd, Namias N, Moore FA, Cha JY, Kerwin A, Langland-Orban B. Measuring trauma system performance: Right patient, right place-mission accomplished? J Trauma Acute Care Surg. 2015;79(2):263–8.
doi: 10.1097/TA.0000000000000660
McCoy CE, Chakravarthy B, Lotfipour S. Guidelines for field triage of injured patients: in conjunction with the morbidity and mortality weekly report published by the center for disease control and prevention. West J Emerg Med. 2013;14(1):69–76.
doi: 10.5811/westjem.2013.1.15981
Jensen KO, Heyard R, Schmitt D, Mica L, Ossendorf C, Simmen HP, Wanner GA, Werner CML, Held L, Sprengel K. Which pre-hospital triage parameters indicate a need for immediate evaluation and treatment of severely injured patients in the resuscitation area? Eur J Trauma Emerg Surg. 2019;45(1):91–8.
doi: 10.1007/s00068-017-0889-0
Dehli T, Monsen SA, Fredriksen K, Bartnes K. Evaluation of a trauma team activation protocol revision: a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2016;24(1):105.
doi: 10.1186/s13049-016-0295-3
Follin A, Jacqmin S, Chhor V, Bellenfant F, Robin S, Guinvarc’h A, Thomas F, Loeb T, Mantz J, Pirracchio R. Tree-based algorithm for prehospital triage of polytrauma patients. Injury. 2016;47(7):1555–61.
doi: 10.1016/j.injury.2016.04.024
Waydhas C, Baacke M, Becker L, Buck B, Dusing H, Heindl B, Jensen KO, Lefering R, Mand C, Paffrath T, et al. A consensus-based criterion standard for the requirement of a trauma team. World J Surg. 2018;42(9):2800–9.
doi: 10.1007/s00268-018-4553-6
Araujo AO, Westphal FL, Lima LC, Correia JO, Gomes PH, Costa EN, Salomao LML, Costa CN. Fatal cardiac trauma in the city of Manaus, Amazonas state, Brazil. Rev Col Bras Cir. 2018;45(4):e1888.
doi: 10.1590/0100-6991e-20181888
Teixeira PG, Inaba K, Oncel D, DuBose J, Chan L, Rhee P, Salim A, Browder T, Brown C, Demetriades D. Blunt cardiac rupture: a 5-year NTDB analysis. J Trauma. 2009;67(4):788–91.
pubmed: 19680160
Yun JH, Byun JH, Kim SH, Moon SH, Park HO, Hwang SW, Kim YH. Blunt traumatic cardiac rupture: single-institution experiences over 14 years. Korean J Thorac Cardiovasc Surg. 2016;49(6):435–42.
doi: 10.5090/kjtcs.2016.49.6.435
Deutsche Gesellschaft für Unfallchirurgie (DGU), Sektion Intensiv- & Notfallmedizin Schwerverletztenversorgung (NIS) Arbeitskreis TraumaRegister, AUC - Akademie der Unfallchirurgie GmbH: TraumaRegister DGU® Jahresbericht 2019 ( https://traumaregister.auc-online.de/fileadmin/user_upload/TR-DGU_Jahresbericht_2019.pdf . Accessed Apr 15 2021.
Pape HC, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, Lichte P, Josten C, Bouillon B, Schmucker U, et al. The definition of polytrauma revisited: an international consensus process and proposal of the new “Berlin definition.” J Trauma Acute Care Surg. 2014;77(5):780–6.
doi: 10.1097/TA.0000000000000453
Tignanelli CJ, Vander Kolk WE, Mikhail JN, Delano MJ, Hemmila MR. Non-compliance with ACS-COT recommended criteria for full trauma team activation is associated with undertriage deaths. J Trauma Acute Care Surg. 2017;84(2):287–94.
doi: 10.1097/TA.0000000000001745
Hamada SR, Gauss T, Duchateau FX, Truchot J, Harrois A, Raux M, Duranteau J, Mantz J, Paugam-Burtz C. Evaluation of the performance of French physician-staffed emergency medical service in the triage of major trauma patients. J Trauma Acute Care Surg. 2014;76(6):1476–83.
doi: 10.1097/TA.0000000000000239
Nan YY, Lu MS, Liu KS, Huang YK, Tsai FC, Chu JJ, Lin PJ. Blunt traumatic cardiac rupture: therapeutic options and outcomes. Injury. 2009;40(9):938–45.
doi: 10.1016/j.injury.2009.05.016
Waydhas C, Trentzsch H, Hardcastle TC, Jensen KO; World-Trauma TAcTIC Study Group. Survey on worldwide trauma team activation requirement. Eur J Trauma Emerg Surg. 2020. https://doi.org/10.1007/s00068-020-01334-z .
Waydhas C, Bieler D, Hamsen U, Baacke M, Lefering R; TraumaRegister DGU. ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement. Eur J Trauma Emerg Surg. 2020. https://doi.org/10.1007/s00068-020-01410-4