Citation

Schellenberg M, Benjamin E, Bardes JM, Inaba K, Demetriades D. J. Trauma Acute Care Surg. 2019; ePub(ePub): ePub.

Affiliation

Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002393

PMID

31205217

Abstract

INTRODUCTION: Trauma team activation (TTA) criteria, set by the ACS Committee on Trauma (COT), are used to identify patients prehospital who are at highest risk for severe injury and mobilize the optimal resources. Patients are undertriaged if they are severely injured (ISS ≥16) but do not meet TTA criteria. This study examined the epidemiology and injury patterns of undertriaged patients and potential clinical effects.

METHODS: All patients presenting to our Level I trauma center (06/01/2017-05/31/18) were screened for inclusion using modified TTA criteria (mTTA), i.e. age >70 added to the standard ACS COT TTA criteria. Demographics, injury/clinical data, and outcomes of undertriaged patients were analyzed. Undertriaged patients were further subcategorized as 'high risk' if they expired or required emergent intervention.

RESULTS: 233 undertriaged patients were identified from 1423 routine trauma consults (16%). Mean ISS was 20 (range 16-43). Most undertriage occurred following blunt trauma (n=224, 96%), especially MVCs (n=66, 28%) and AVPs (n=57, 24%). Thirty-two patients (14%) were identified as high risk undertriaged patients: 16 (50%) required emergency surgery (mainly craniectomy; n=10, 63%), 5 (16%) required angioembolization, and 14 patients (44%) died. In this high risk group, the cause of death was almost exclusively traumatic brain injury (TBI) (n=13, 93%). Of the patients who died of TBI, the majority had a depressed GCS on presentation to the ED (<11) (n=10, 77%) despite not meeting field criteria for TTA.

CONCLUSIONS: Using mTTA criteria, undertriage rates are relatively low, particularly after penetrating trauma. However, there is a high risk population that is not captured, among whom mortality and need for emergent intervention are high. Most undertriage deaths are secondary to severe TBI. Despite not qualifying for highest level activation, patients with head trauma and GCS <11 on admission are at high risk for adverse outcomes and additional resource mobilization should be considered. LEVEL OF EVIDENCE: III STUDY TYPE: Prognostic and Epidemiological.

Language: en