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Citation
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Maiga AW, Vella MA, Appelbaum RD, Irlmeier R, Ye F, Holena DN, Dumas RP. J. Trauma Acute Care Surg. 2023; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Minutes matter for trauma patients in hemorrhagic shock. How trauma team function impacts time to the next phase of care has not been rigorously evaluated. We hypothesized better team performance scores to be associated with decreased time to the next phase of trauma care.
METHODS: This retrospective secondary analysis of a prospective multicenter observational study included hypotensive trauma patients at 19 centers. Using Trauma Video Review, we analyzed team performance with the validated T-NOTECHS scale (non-technical skills scale for trauma): leadership, cooperation and resource management, communication, assessment/decision making, and situational awareness. The primary outcome was minutes from patient arrival to next phase of care; deaths in the bay were excluded. Secondary outcomes included time to initiation and completion of first unit of blood and inpatient mortality. Associations between team dynamics and outcomes were assessed with a linear mixed effects model adjusting for injury severity score (ISS), mechanism, initial blood pressure and heart rate, number of team members, and trauma team lead training level and gender.
RESULTS: 441 patients were included. The median ISS was 22 [IQR:10-34] and most (61%) sustained blunt trauma. Median time to next phase of care was 23.5 [17-35] minutes. Better leadership, communication, assessment/decision making, and situational awareness scores were associated with faster times to next phase of care (all p < 0.05). Each 1-point worsening in the T-NOTECHS score (scale:5-15) was associated with 1.6 minutes more in the bay. The median resuscitation team size was 12 [10-15], and larger teams were slower (p < 0.05). Better situational awareness was associated with faster completion of first unit of blood by 4-5 minutes (p < 0.05).
CONCLUSIONS: Better team performance is associated with faster transitions to next phase of care in hypotensive trauma patients, and larger teams are slower. Trauma team training should focus on optimizing team performance to facilitate faster hemorrhage control. LEVEL OF EVIDENCE: Level III.
Language: en |