Archives of Trauma Research

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 6  |  Issue : 3  |  Page : 15--19

Optimization of trauma care: A two-tiered inhospital trauma team response system


Annelieke Maria Karien Harmsen1, Georgios Fredericus Giannakopoulos1, Kaoutar Azijli2, Tessa Biesheuvel2, Leo Maria George Geeraedts1, Frank Willem Bloemers1 
1 Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
2 Department of Emergency Medicine, VU University Medical Center, Amsterdam, The Netherlands

Correspondence Address:
Annelieke Maria Karien Harmsen
De Boelelaan 117, 1081 HV Amsterdam
The Netherlands

Background: To improve utilization of resources and reduce overtriage, two-tiered trauma team activation (TTA) system was implemented. The system activates a complete or selective trauma team (CTT, STT). Activation is based on the mechanism of injury (MOI), prehospital vital signs and injuries. Objectives: The objective was to evaluate the feasibility, effectiveness and safety of the implementation of a two-tiered system and whether the triage is done according to the TTA criteria. Methods: A prospective observational study was performed at the emergency department (ED) of a Level I trauma center. Data were collected on TTA criteria, patient demographics, MOI, prehospital vital signs, imaging modalities and blood gas analysis in the ED and inhospital data. Results: In 3 months, 186 patients were presented to the trauma resuscitation room. Thirty-four patients were excluded, 152 patients were included for analysis. Median age was 48 years (range 1–93), 64% were males. In 73%, the CTT was activated, in 27% the STT, the STT was upgraded three times. Seventy-nine patients had to be admitted, the median length of stay was 5 days (range 1–62). Thirty-eight patients needed Intensive Care Unit (ICU) admission; the median ICU stay was 3 days (range 1–33). Three patients died in the resuscitation room, in total, nine patients died. Overtriage was 29% and undertriage 7%. No significant difference was found for mortality, duration of hospital admission or ICU admission across the four groups (correct activation STT, undertriage, overtriage, and correct activation CTT). Conclusions: This TTA system identifies those patients in need of a CTT adequately with an undertriage percentage of 7%, indicative of improved care for the severely injured and a more appropriate use of resources. With this model, the overtriage is set to an acceptable percentage of 29%.


How to cite this article:
Karien Harmsen AM, Giannakopoulos GF, Azijli K, Biesheuvel T, George Geeraedts LM, Bloemers FW. Optimization of trauma care: A two-tiered inhospital trauma team response system.Arch Trauma Res 2017;6:15-19


How to cite this URL:
Karien Harmsen AM, Giannakopoulos GF, Azijli K, Biesheuvel T, George Geeraedts LM, Bloemers FW. Optimization of trauma care: A two-tiered inhospital trauma team response system. Arch Trauma Res [serial online] 2017 [cited 2024 Mar 29 ];6:15-19
Available from: https://www.archtrauma.com/article.asp?issn=2251-953X;year=2017;volume=6;issue=3;spage=15;epage=19;aulast=Karien;type=0