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. 2022 Oct;92(10):2628-2634.
doi: 10.1111/ans.17906. Epub 2022 Jul 14.

Failure to initiate trauma team activation for patients who meet the criteria in a level 1 paediatric trauma centre: which patients are missing out?

Jonghoo Sung  1 , Angela Yao  1 , Georgia Antoniou  2 , Rebecca Cooksey  3   4 , Jacqueline Winters  3   5 , Michael Ee  3   4 , Nicole Williams  1   3
Affiliations

Failure to initiate trauma team activation for patients who meet the criteria in a level 1 paediatric trauma centre: which patients are missing out?

Jonghoo Sung et al. ANZ J Surg. 2022 Oct.

Abstract

Background: Trauma team activation (TTA) is paramount in the early hospital management of trauma patients. This study aimed to evaluate factors which contribute to failure to activate the Trauma team for management of paediatric trauma.

Methods: A retrospective cohort study of Emergency Department (ED) presentations at the paediatric major trauma hospital in Adelaide, South Australia was conducted over a 16-month period. Data from the hospital's trauma registry, individual case files and digital medical records were evaluated to determine factors that were associated with no TTA.

Results: During the study period, 617 trauma patients who met Level 1 or Level 2 TTA criteria attended the trauma centre. For 29 (4.7%) of these patients, there was no TTA. Predictors of no TTA included sustaining abdomen and/or pelvis injuries compared to limb injuries (unadjusted odds ratio [OR] = 10.59, 95% confidence interval [CI] 1.98-56.69, P = 0.006), sustaining non-accidental injury (NAI) versus an injury with vehicle involvement (OR = 30.13, 95% CI 6.43-141.21, P < 0.001), and arriving via emergency medical retrieval service compared to private vehicle (OR = 14.23, 95% CI 3.94-51.36, P < 0.001). No patients transferred directly to Paediatric Intensive Care Unit (PICU), or High Dependency Unit (HDU) received an appropriate TTA.

Conclusion: Multiple factors were associated with no TTA in paediatric trauma patients. The results highlight that even in PICU and HDU admissions and transfer patients, vigilant clarification of mechanism of injury and potential for occult injuries should be undertaken to ensure appropriate TTA and improve patient outcome.

Keywords: emergency medical services; orthopaedic surgery; paediatric hospitals; paediatric surgery; trauma; trauma centres; triage.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Flowsheet demonstrating the number of patients each classified into the appropriate levels of TTA when activated and not activated.
See this image and copyright information in PMC

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