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Differences in trauma team activation criteria among Norwegian hospitals.

Larsen KT, Uleberg O, Skogvoll E - Scand J Trauma Resusc Emerg Med (2010)

Bottom Line: The median number of criteria per hospital was 23 (range 8-40), with a total number of 156 and wide variation with respect to physiological "cut-off" values.The mechanism of injury was commonly in use despite a well-known, large over-triage rate.These criteria show considerable variation, including physiological "cut-off" values.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

ABSTRACT

Background: To ensure the rapid and correct triage of patients in potential need of specialized treatment, Norwegian hospitals are expected to establish trauma teams with predefined criteria for their activation. The objective of this study was to map and describe the criteria currently in use.

Methods: We undertook a cross-sectional survey in the summer of 2008, using structured telephone interviews to all Norwegian hospitals that might admit severely injured patients.

Results: Forty-nine hospitals were included, of which 48 (98%) had a trauma team and 20 had a hospital-based trauma registry. Criteria for trauma team activation were found at 46 (94%) hospitals. No single criterion was common to all hospitals. The median number of criteria per hospital was 23 (range 8-40), with a total number of 156 and wide variation with respect to physiological "cut-off" values. The mechanism of injury was commonly in use despite a well-known, large over-triage rate.

Conclusions: In recent years, Norwegian hospitals have gradually established trauma teams and criteria for their activation. These criteria show considerable variation, including physiological "cut-off" values.

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Distribution of values on the Glasgow Coma Scale (GCS) as a criterion for trauma team activation.
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Figure 3: Distribution of values on the Glasgow Coma Scale (GCS) as a criterion for trauma team activation.

Mentions: The two most frequently used physiological criteria were "level of consciousness" ("LEOC") and "hypotension", which were used by 37 hospitals. However, the "cut off" values for LEOC showed considerable variation (Figure 3). Three hospitals used two versions simultaneously: one based on the Glasgow Coma Scale and the other an unspecific criterion called "reduced consciousness". "Hypotension" was either defined as "systolic blood pressure < 90 mmHg", or less specifically as "hypotension", "decreasing blood pressure", or "lack of pulse in the radial artery". Miscellaneous respiratory symptoms was the third largest group, with criteria such as "superficial respiration", "dyspnoea", "stridor", or "airway obstruction". The frequently used criterion, "ventilation rate", also had different cut-off values (Figure 4). "Pulse rate" was used by 20 hospitals, with an upper limit > 120 or > 130 beats per min. Only one hospital specified a lower limit: < 60 beats per min. Other physiologic criteria were "convulsions", "abnormal pupils", "abnormal skin color", "delayed capillary refill", "hypothermia", and "low oxygen saturation". Three hospitals included "Trauma Score" (TS) or "Revised Trauma Score" (RTS) as one of their TTA criteria, with cut off values of < 9 (TS, range 1-16) or < 11 and < 12 (RTS, range 0-12), respectively [21,22].


Differences in trauma team activation criteria among Norwegian hospitals.

Larsen KT, Uleberg O, Skogvoll E - Scand J Trauma Resusc Emerg Med (2010)

Distribution of values on the Glasgow Coma Scale (GCS) as a criterion for trauma team activation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2874509&req=5

Figure 3: Distribution of values on the Glasgow Coma Scale (GCS) as a criterion for trauma team activation.
Mentions: The two most frequently used physiological criteria were "level of consciousness" ("LEOC") and "hypotension", which were used by 37 hospitals. However, the "cut off" values for LEOC showed considerable variation (Figure 3). Three hospitals used two versions simultaneously: one based on the Glasgow Coma Scale and the other an unspecific criterion called "reduced consciousness". "Hypotension" was either defined as "systolic blood pressure < 90 mmHg", or less specifically as "hypotension", "decreasing blood pressure", or "lack of pulse in the radial artery". Miscellaneous respiratory symptoms was the third largest group, with criteria such as "superficial respiration", "dyspnoea", "stridor", or "airway obstruction". The frequently used criterion, "ventilation rate", also had different cut-off values (Figure 4). "Pulse rate" was used by 20 hospitals, with an upper limit > 120 or > 130 beats per min. Only one hospital specified a lower limit: < 60 beats per min. Other physiologic criteria were "convulsions", "abnormal pupils", "abnormal skin color", "delayed capillary refill", "hypothermia", and "low oxygen saturation". Three hospitals included "Trauma Score" (TS) or "Revised Trauma Score" (RTS) as one of their TTA criteria, with cut off values of < 9 (TS, range 1-16) or < 11 and < 12 (RTS, range 0-12), respectively [21,22].

Bottom Line: The median number of criteria per hospital was 23 (range 8-40), with a total number of 156 and wide variation with respect to physiological "cut-off" values.The mechanism of injury was commonly in use despite a well-known, large over-triage rate.These criteria show considerable variation, including physiological "cut-off" values.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

ABSTRACT

Background: To ensure the rapid and correct triage of patients in potential need of specialized treatment, Norwegian hospitals are expected to establish trauma teams with predefined criteria for their activation. The objective of this study was to map and describe the criteria currently in use.

Methods: We undertook a cross-sectional survey in the summer of 2008, using structured telephone interviews to all Norwegian hospitals that might admit severely injured patients.

Results: Forty-nine hospitals were included, of which 48 (98%) had a trauma team and 20 had a hospital-based trauma registry. Criteria for trauma team activation were found at 46 (94%) hospitals. No single criterion was common to all hospitals. The median number of criteria per hospital was 23 (range 8-40), with a total number of 156 and wide variation with respect to physiological "cut-off" values. The mechanism of injury was commonly in use despite a well-known, large over-triage rate.

Conclusions: In recent years, Norwegian hospitals have gradually established trauma teams and criteria for their activation. These criteria show considerable variation, including physiological "cut-off" values.

Show MeSH
Related in: MedlinePlus