Do trauma teams make a difference?A single centre registry study

Timothy H. Rainer, N.K. Cheung, JTimothy H. Rainer, N.K. Cheung, Janice H.H. Yeung, Colin A. Grahaanice H.H. Yeung, Colin A. Graha

mm

Objective

• To evaluate the association between To evaluate the association between trauma team activation according to trauma team activation according to well-established protocols and patient well-established protocols and patient survivalsurvival

Materials and Methods• Emergency department of the Prince of WEmergency department of the Prince of W

ales Hospital between Jan 2001 and Dec ales Hospital between Jan 2001 and Dec 20052005

• First responseFirst response• Three emergency physicians and three nurseThree emergency physicians and three nurse

ss• Second responseSecond response

• Response to “trauma call”Response to “trauma call”• Two general surgeons, an orthopaedic surgeoTwo general surgeons, an orthopaedic surgeo

n and ICU physiciann and ICU physician

Trauma call activation criteria

If any single criteria was met then a trauma call should be activated

Materials and Methods

• Correct callCorrect call• Activation of the trauma call when indicateActivation of the trauma call when indicate

d according to predetermined guidelinesd according to predetermined guidelines

• UndercallUndercall• A call was indicated according to the guidelA call was indicated according to the guidel

ines but not activatedines but not activated

Materials and Methods

• Primary outcomePrimary outcome• MortalityMortality ：： death within 28 days of injurydeath within 28 days of injury

• Second outcomeSecond outcome• Operation within 6 hoursOperation within 6 hours• Need for ICUNeed for ICU

Results

• 150593 patients attended the ED with a150593 patients attended the ED with an injuryn injury

• 674 patient meet criteria674 patient meet criteria• 482482 （（ 72%72% ）） were correct trauma callswere correct trauma calls• 192192 （（ 28%28% ）） were undercallswere undercalls

Correct calls and undercalls

Results

• Uni-variate analysis revealed that the folUni-variate analysis revealed that the following factors were associated with undlowing factors were associated with undercallercall• Aged>65 years old Aged>65 years old • FemaleFemale• Injury results from fallsInjury results from falls• Pre-injury comorbidityPre-injury comorbidity

Trauma call criteria

Undercall factor

Probability of Survival

• Undercall group was generally higher thUndercall group was generally higher than the correct groupan the correct group

• Undercall group was less requirements Undercall group was less requirements for urgent operation and ICU carefor urgent operation and ICU care

• Odds ratio for death was 7.1 in the undeOdds ratio for death was 7.1 in the undercall group for those patients with a modrcall group for those patients with a moderate to low probability of survivalerate to low probability of survival （（ PsPs=0.5~7.5=0.5~7.5 ））

Probability of Survival

Probability of Survival

Discussion

• 28% patients are undercall28% patients are undercall• Trauma calls were not activated in a sigTrauma calls were not activated in a sig

nificant proportion of patients of aged>6nificant proportion of patients of aged>65years old, with falls, respiratory compr5years old, with falls, respiratory compromise, moderate degrees of hypovolaeomise, moderate degrees of hypovolaemic shock and GCS between 9 and 13mic shock and GCS between 9 and 13

Why under call was happen ？ • Trauma team leader use their judgemenTrauma team leader use their judgemen

t in interpreting applicationt in interpreting application• Elderly female suffered from low energy Elderly female suffered from low energy

falls and difficult to differentiate external falls and difficult to differentiate external blunt head injury from acute strokeblunt head injury from acute stroke

• Some of trauma call criteria are non-speSome of trauma call criteria are non-specific and qualitativecific and qualitative

Why under call was happen ？• Many of the criteria may only be met for Many of the criteria may only be met for

a short perioda short period• Some of the anatomical criteria are Some of the anatomical criteria are

ambiguousambiguous• A trauma call would not be result in any A trauma call would not be result in any

significant change in managementsignificant change in management

Discussion

• Undercall made little difference with a vUndercall made little difference with a very lower probability of survivalery lower probability of survival （（ Ps=0Ps=0~0.5~0.5 ）） who were likely to die no matter who were likely to die no matter the interventionthe intervention

• Undercall made no difference to patientUndercall made no difference to patients with a high probability of survivals with a high probability of survival （（ PsPs=0.75~1=0.75~1 ）） who were likely to live no mwho were likely to live no matter the interventionatter the intervention

Discussion

• In the group with moderate probability of In the group with moderate probability of survivalsurvival （（ Ps=0.5~0.75Ps=0.5~0.75 ）） show odds rshow odds ratio for mortality in the undercall verus tatio for mortality in the undercall verus the correct call was 7.6he correct call was 7.6• Undercall increased the probability of deatUndercall increased the probability of deat

h over seven foldsh over seven folds