Trauma Team Activation: improved care of major trauma patients

Abstract

Aim: To assess whether Trauma Team Activation (TTA) at Christchurch Hospital is associated with reduced mortality or improves in-hospital care for major trauma patients, and review differences in the two-tier activation system (Trauma Call versus Trauma Standby).

Methods: A retrospective observational study of major trauma patients presenting to Christchurch Emergency Department (ED) 2018-2019. Univariate analyses were undertaken followed by multivariate analyses controlling for age and injury severity score (ISS).

Results: Major trauma patients with a TTA had a higher mean ISS (p<0.001) compared to patients without TTA. After controlling for age and ISS, TTA was associated with decreased time to CT (p<0.001), and shorter ED length of stay (LOS) (p<0.001). Despite an increased rate of surgery (OR 1.9, 95%CI:1.2-3.0) and admission to ICU (OR 4.1, 95%CI:2.0-8.5), with longer total hospital LOS (p<0.001). When compared to those with a Trauma Standby, patients with a full Trauma Call had a higher mortality (OR 1.5, 95%CI:0.3-8.4), increased rates of surgery (OR 2.7, 95%CI:1.4-5.2) and ICU admission (OR 17.9, 95%CI:4.2-77.4), with a longer hospital LOS (p=0.006).

Conclusion: TTA was associated with decreased time to diagnostic imaging and definitive management in major trauma patients. Whilst causation cannot be inferred, these trends were apparent after controlling for age and ISS.