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European Journal of Trauma and Emergency Surgery

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24.06.2020 | Original Article

Trauma-team-activation in Germany: how do emergency service professionals use the activation due to trauma mechanism? Results from a nationwide survey

verfasst von: Paul Hagebusch, Philipp Faul, Frank Naujoks, Alexander Klug, Reinhard Hoffmann, Uwe Schweigkofler

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 1/2022

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Abstract

Background

Trauma team activation (TTA) requires significant human and financial resources. The implemented German guidelines reduced the mortality of severe injured patients significantly over the last decade. Up to now there is no two-tier trauma team activation protocol in Germany. A two-tier TTA [often activated due to trauma mechanism (TM)] is thought to be a reasonable way to maintain patient safety while increasing cost efficiency.

Methods

We created an online survey addressed at the Emergency Medical Service in Germany to conduct a cross-sectional study. Both physicians and rescue service professionals (RSPs) were included. A minimum of 1550 participants answered questions in 4 different categories concerning the aspects of limited-TTA (L-TTA). Case studies were presented to evaluate the usage of TTA due to TM in the daily routine.

Results

Eighty percent (n:1233) of the respondents wish for a possibility to activate a limited trauma team. Seventy-two percent (n: 1109) of the participants consider a L-TTA due to TM to be adequate. There were significant differences (p < 0.05) in the assessment and opinion on L-TTA among physicians and RSPs as well as different medical professions. The evaluated case studies showed diverse answers: depending on the profession, the same patient was ranked as severely injured by 54% and as minorly injured by 46% of the 1550 participants.

Conclusions

Members of the German Emergency Medical Service call for a two-tier TTA-protocol. Up to now we cannot fully recommend an automatic reduction of the trauma team when activated due to TM in Germany with the guidelines implemented. The profession might affect the L-TTA-behavior. Criteria for a L-TTA in Germany have to be defined and evaluated.

Level of evidence

IV, cross-sectional study.

Nur mit Berechtigung zugänglich

Leading cause of death by age group. Am Assoc Surg Trauma. https://www.aast.org/trauma-facts (2004). Accessed 11 February 2020.

GBD Collaborators 2015 M and C of D. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–544. https://doi.org/10.1016/S0140-6736(16)31012-1.CrossRef

Schoeneberg C, Schilling M, Keitel J, et al. TraumaNetwork, trauma registry of the DGU®, whitebook, S3 guideline on treatment of polytrauma/severe injuries—an approach for validation by a retrospective analysis of 2304 patients (2002–2011) of a level 1 trauma centre TT - traumanetzwerk. TraumaReg Zentralbl Chir. 2017;142:199–208. https://doi.org/10.1055/s-0033-1360225.CrossRefPubMed

Bouillon B, Pieper D. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung AWMF Register-Nr. 012/019 2016:424.

Marzi I, Lustenberger T, Störmann P, et al. Increasing overhead ressources of the trauma room. Unfallchirurg. 2019;122:53–8. https://doi.org/10.1007/s00113-018-0484-9.CrossRefPubMed

Committee on Trauma, American College of Surgeons. Resources for the optimal care of the injured patient 2014. 6th ed. 2014. p. 25–9.

Braken P, Amsler F, Gross T. Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU^® may significantly improve overtriage—a cross sectional study. Scand J Trauma Resusc Emerg Med. 2018;26:1–10. https://doi.org/10.1186/s13049-018-0498-x.CrossRef

Newgard CD, Staudenmayer K, Hsia RY, et al. The cost of overtriage: more than one-third of low-risk injured patients were taken to major trauma centers. Health Aff. 2013;32:1591–9. https://doi.org/10.1377/hlthaff.2012.1142.CrossRef

Ochsner MG, Schmidt JA, Rozycki GS, et al. The evaluation of a two-tier trauma response system at a major trauma center: is it cost effective and safe? J Trauma. 1995;39:971–7. https://doi.org/10.1097/00005373-199511000-00025.CrossRefPubMed

10.

Rehn M, Lossius HM, Tjosevik KE, et al. Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre. Br J Surg. 2012;99:199–208. https://doi.org/10.1002/bjs.7794.CrossRefPubMedPubMedCentral

11.

Jenkins P, Rogers J, Kehoe A, et al. An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre. Emerg Med J. 2015;32:364–7. https://doi.org/10.1136/emermed-2013-203402.CrossRefPubMed

12.

Linder F, Holmberg L, Bjorck M, et al. A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden—the TRAUMALERT study. Scand J Trauma Resusc Emerg Med. 2019;27:1–10. https://doi.org/10.1186/s13049-019-0619-1.CrossRef

13.

Boyle MJ, Smith EC, Archer F. Is mechanism of injury alone a useful predictor of major trauma? Injury. 2008;39:986–92. https://doi.org/10.1016/j.injury.2008.03.015.CrossRefPubMed

14.

Davis T, Dinh M, Roncal S, et al. Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma referral hospital. Injury. 2010;41:470–4. https://doi.org/10.1016/j.injury.2010.01.003.CrossRefPubMed

15.

Sasser SM, Hunt RC, Faul M, et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on field triage. Prehospital Control Trauma Extern Hemorrhage Lit Rev Evid Anal Tourniquets Hemostatic Dressings. 2011;2012:155–86. https://doi.org/10.1542/peds.2009-0257.CrossRef

16.

Voskens FJ, Van Rein EAJ, Van Der Sluijs R, et al. Accuracy of prehospital triage in selecting severely injured trauma patients. JAMA Surg. 2018;153:322–7. https://doi.org/10.1001/jamasurg.2017.4472.CrossRefPubMed

17.

Baker S, O’Neil B, Haddon W, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.CrossRefPubMed

18.

Hsu SY, Wu SC, Rau CS, et al. Impact of adapting the abbreviated injury scale (AIS)-2005 from AIS-1998 on injury severity scores and clinical outcome. Int J Environ Res Public Health. 2019. https://doi.org/10.3390/ijerph16245033.CrossRefPubMedPubMedCentral

19.

Waydhas C, Trentzsch H, Hardcastle TC, et al. Survey on worldwide trauma team activation requirement. Eur J Trauma Emerg Surg. 2020. https://doi.org/10.1007/s00068-020-01334-z.CrossRefPubMedPubMedCentral

20.

Schweigkofler U, Sauter M, Wincheringer D, et al. Emergency room activation due to trauma mechanism TT - Schockraumindikation nach Unfallhergang. Unfallchirurg. 2019. https://doi.org/10.1007/s00113-019-00733-1.CrossRefPubMed

21.

Miller RT, Nazir N, McDonald T, et al. The modified rapid emergency medicine score: a novel trauma triage tool to predict in-hospital mortality. Injury. 2017. https://doi.org/10.1016/j.injury.2017.04.048.CrossRefPubMed

22.

Jones CMC, Cushman JT, Lerner EB, et al. Prehospital trauma triage decision-making: a model of what happens between the 9–1–1 call and the hospital. Prehospital Emerg Care. 2016. https://doi.org/10.3109/10903127.2015.1025157.CrossRef

23.

Jeong JH, Park YJ, Kim DH, et al. The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction. BMC Surg. 2017. https://doi.org/10.1186/s12893-017-0272-4.CrossRefPubMedPubMedCentral

24.

Van Rein EAJ, Van Der Sluijs R, Voskens FJ, et al. Development and validation of a prediction model for prehospital triage of trauma patients. JAMA Surg. 2019. https://doi.org/10.1001/jamasurg.2018.4752.CrossRefPubMedPubMedCentral

25.

Van Rein EAJ, Houwert RM, Gunning AC. Accuracy of prehospital triage protocols in selecting severely injured patients: a systematic review. J Trauma Acute Care Surg. 2017;83:328–39. https://doi.org/10.1097/TA.0000000000001516.CrossRefPubMed

26.

Newgard CD, Lin A, Eckstrom E, et al. Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults. J Trauma Acute Care Surg. 2019;86:829–37. https://doi.org/10.1097/TA.0000000000002195.CrossRefPubMedPubMedCentral

27.

Connolly R, Woo MY, Lampron J, Perry JJ. Factors associated with delay in trauma team activation and impact on patient outcomes. Can J Emerg Med. 2018;20:606–13. https://doi.org/10.1017/cem.2017.389.CrossRef

28.

Skjøt-Arkil H, Pontoppidan LL, Laursen JO, et al. Do prehospital providers and emergency nurses agree on triage assignment?: an efficacy study. Eur J Emerg Med. 2019;26:29–33. https://doi.org/10.1097/MEJ.0000000000000503.CrossRefPubMed

29.

Dallaire C, Poitras J, Aubin K, Lavoie A, Moore L, Audet G. Interrater agreement of Canadian Emergency Department Triage and Acuity scale scores assigned by base hospital and emergency department nurses. Can J Emerg Med. 2010;12:45–9. https://doi.org/10.1017/S148180350001201X.CrossRef

30.

Meissler R, Berlac P. Prehospital trauma triage before and after deployment of a physician-manned mobile emergency care unit in Nordsjaelland. Ugeskr Laeger. 2009;171:2548–52.

31.

Linder F, Holmberg L, Eklöf H, et al. Better compliance with triage criteria in trauma would reduce costs with maintained patient safety. Eur J Emerg Med. 2019;26:283–8. https://doi.org/10.1097/MEJ.0000000000000544.CrossRefPubMed

32.

Tignanelli CJ, Vander Kolk WE, Mikhail JN, et al. Noncompliance with American College of Surgeons Committee on Trauma recommended criteria for full trauma team activation is associated with undertriage deaths. J Trauma Acute Care Surg. 2018. https://doi.org/10.1097/TA.0000000000001745.CrossRefPubMed

Titel: Trauma-team-activation in Germany: how do emergency service professionals use the activation due to trauma mechanism? Results from a nationwide survey
verfasst von: Paul Hagebusch
Philipp Faul
Frank Naujoks
Alexander Klug
Reinhard Hoffmann
Uwe Schweigkofler
Publikationsdatum: 24.06.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 1/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01425-x

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Trauma-team-activation in Germany: how do emergency service professionals use the activation due to trauma mechanism? Results from a nationwide survey

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Methods

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Conclusions

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Level of evidence

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