Raising the Threshold for Trauma Team Activation Decreases Workload Without Consequence

A general tendency exists to overtriage patients to trauma centers and to activate trauma teams. Trauma team activation requires numerous personnel and the attending trauma surgeon to arrive within 20 minutes. In a retrospective observational study, researchers at a single level I trauma center determined whether changing criteria for trauma team activation from those recommended by the American College of Surgeons Committee on Trauma to more-aggressive indications affects patient outcomes. Criteria for trauma team activation were changed to decrease the systolic blood pressure cutoff (from <90 mm Hg to <80 mm Hg), decrease the respiratory rate cutoff (from <10 or >28 to <8 or >28 breaths per minute), eliminate the heart rate criterion, decrease the Glasgow Coma Scale score cutoff (from <14 to <9), and eliminate the following three anatomic criteria: pelvic fracture, flail chest, and ≥2 long bone fractures.

Researchers compared trauma registry data for 1955 patients who were admitted during an 18-month period before the criteria were changed and for 1844 patients who were admitted during an 18-month period after the change; 95% of patients had blunt injuries. After the change, the proportion of cases that led to trauma team activation was significantly lower overall (18% vs. 12%) and during nights and weekends (19% vs. 13%). The mean Injury Severity Score among cases that led to trauma team activation was significantly higher after the change (22.96 vs. 28.57), yet mortality did not change significantly. Among patients with systolic BP between 80 and 90 mm Hg, mortality decreased after the change (7 deaths among 23 patients vs. 0 deaths among 22 patients). The percentage of laparotomies that were performed more than 2 hours after arrival did not change.