Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers
<b>Background/Objective: </b>This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential consequences, and relate these with different Trauma Team Activ...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-03-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/13/6/1714 |
| _version_ | 1797240529636818944 |
|---|---|
| author | Helena Düsing Paul Hagebusch Markus Baacke Dan Bieler Michael Caspers Valentin Clemens Matthias Fröhlich Lisa Hackenberg Renè Hartensuer Sebastian Imach Kai Oliver Jensen Annette Keß Christian Kleber Fabian Laue Rolf Lefering Mindaugas Maslauskas Gerrit Matthes André Nohl Orkun Özkurtul Thomas Paffrath Vera Pedersen Tristan Pfläging Kai Sprengel Philipp Störmann Heiko Trentzsch Christian Waydhas Uwe Schweigkofler on behalf of the NIS-Trauma TAcTIC Study Group |
| author_facet | Helena Düsing Paul Hagebusch Markus Baacke Dan Bieler Michael Caspers Valentin Clemens Matthias Fröhlich Lisa Hackenberg Renè Hartensuer Sebastian Imach Kai Oliver Jensen Annette Keß Christian Kleber Fabian Laue Rolf Lefering Mindaugas Maslauskas Gerrit Matthes André Nohl Orkun Özkurtul Thomas Paffrath Vera Pedersen Tristan Pfläging Kai Sprengel Philipp Störmann Heiko Trentzsch Christian Waydhas Uwe Schweigkofler on behalf of the NIS-Trauma TAcTIC Study Group |
| author_sort | Helena Düsing |
| collection | DOAJ |
| description | <b>Background/Objective: </b>This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential consequences, and relate these with different Trauma Team Activation Protocols (TTA-Protocols), as this has not been done before in Germany. <b>Methods</b>: Each trauma center collected the data during a three-month period between December 2019 and February 2021. All 12 participating hospitals are certified as supra-regional trauma centers. Here, we report a subgroup analysis of undertriaged patients. Those included in the study were all consecutive adult patients (age ≥ 18 years) with acute trauma admitted to the emergency department of one of the participating hospitals by the prehospital emergency medical service (EMS) within 6 h after trauma. The data contained information on age, sex, trauma mechanism, pre- and in-hospital physiology, emergency interventions, emergency surgical interventions, intensive care unit (ICU) stay, and death within 48 h. Trauma team activation (TTA) was initiated by the emergency medical services. This should follow the national guidelines for severe trauma using established field triage criteria. We used various denominators, such as ISS, and criteria for the appropriateness of TTA to evaluate the undertriage in four groups. <b>Results</b>: This study included a total of 3754 patients. The average injury severity score was 5.1 points, and 7.0% of cases (<i>n</i> = 261) presented with an injury severity score (ISS) of 16+. TTA was initiated for a total of 974 (26%) patients. In group 1, we evaluated how successful the actual practice in the EMS was in identifying patients with ISS 16+. The undertriage rate was 15.3%, but mortality was lower in the undertriage cohort compared to those with a TTA (5% vs. 10%). In group 2, we evaluated the actual practice of EMS in terms of identifying patients meeting the appropriateness of TTA criteria; this showed a higher undertriage rate of 35.9%, but as seen in group 1, the mortality was lower (5.9% vs. 3.3%). In group 3, we showed that, if the EMS were to strictly follow guideline criteria, the rate of undertriage would be even higher (26.2%) regarding ISS 16+. Using the appropriateness of TTA criteria to define the gold standard for TTA (group 4), 764 cases (20.4%) fulfilled at least one condition for retrospective definition of TTA requirement. <b>Conclusions</b>: Regarding ISS 16+, the rate of undertriage in actual practice was 15.3%, but those patients did not have a higher mortality. |
| first_indexed | 2024-04-24T18:08:53Z |
| format | Article |
| id | doaj.art-27dd60ef28f544caae1d549e1eccbd2b |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-04-24T18:08:53Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-27dd60ef28f544caae1d549e1eccbd2b2024-03-27T13:48:07ZengMDPI AGJournal of Clinical Medicine2077-03832024-03-01136171410.3390/jcm13061714Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma CentersHelena Düsing0Paul Hagebusch1Markus Baacke2Dan Bieler3Michael Caspers4Valentin Clemens5Matthias Fröhlich6Lisa Hackenberg7Renè Hartensuer8Sebastian Imach9Kai Oliver Jensen10Annette Keß11Christian Kleber12Fabian Laue13Rolf Lefering14Mindaugas Maslauskas15Gerrit Matthes16André Nohl17Orkun Özkurtul18Thomas Paffrath19Vera Pedersen20Tristan Pfläging21Kai Sprengel22Philipp Störmann23Heiko Trentzsch24Christian Waydhas25Uwe Schweigkofler26on behalf of the NIS-Trauma TAcTIC Study GroupDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, GermanyDepartment of Trauma Surgery and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt, 60389 Frankfurt am Main, GermanyDepartment of Trauma Surgery, Hospital of the Merciful Brothers Trier, 54292 Trier, GermanyDepartment for Trauma Surgery and Orthopedics, Reconstructive Surgery, Hand Surgery, Burn Medicine German Armed Forces Central Hospital Koblenz, 56072 Koblenz, GermanyDepartment of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimerstr. 200, 51109 Cologne, GermanyDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU Klinikum, 80336 München, GermanyDepartment of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimerstr. 200, 51109 Cologne, GermanyDepartment for Trauma Surgery and Orthopedics, Reconstructive Surgery, Hand Surgery, Burn Medicine German Armed Forces Central Hospital Koblenz, 56072 Koblenz, GermanyDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, GermanyDepartment of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimerstr. 200, 51109 Cologne, GermanyDepartment of Trauma, University Hospital Zurich (USZ), Raemistr. 100, 8091 Zurich, SwitzerlandDepartment of Orthopaedics, Trauma Surgery and Plastic Surgery, Leipzig University Hospital, Liebigstr. 16, 04103 Leipzig, GermanyDepartment of Orthopaedics, Trauma Surgery and Plastic Surgery, Leipzig University Hospital, Liebigstr. 16, 04103 Leipzig, GermanyDepartment of Trauma and Reconstructive Surgery, Ernst von Bergmann Klinikum Potsdam, 14467 Potsdam, GermanyInstitute for Research in Operative Medicine (IFOM), Witten/Herdecke University, 51067 Köln, GermanyDepartment of Trauma Surgery, Hospital of the Merciful Brothers Trier, 54292 Trier, GermanyDepartment of Trauma and Reconstructive Surgery, Ernst von Bergmann Klinikum Potsdam, 14467 Potsdam, GermanyCenter for Emergency Medicine, BG Klinikum Duisburg, 47249 Duisburg, GermanyDepartment of Orthopaedics, Trauma Surgery and Plastic Surgery, Leipzig University Hospital, Liebigstr. 16, 04103 Leipzig, GermanyDepartment of Trauma and Hand Surgery, Cellitinnen-Severinsklösterchen, Augustinerinnen Hospital, 50678 Köln, GermanyDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU Klinikum, 80336 München, GermanyDepartment for Trauma Surgery and Orthopedics, Reconstructive Surgery, Hand Surgery, Burn Medicine German Armed Forces Central Hospital Koblenz, 56072 Koblenz, GermanyHirslanden Clinic St. Anna, Faculty of Health Sciences and Medicine, University of Lucerne, 6006 Lucerne, SwitzerlandDepartment of Trauma and Orthopedic Surgery, University Hospital Frankfurt, 60596 Frankfurt am Main, GermanyInstitut für Notfallmedizin und Medizinmanagement (INM), LMU Klinikum, LMU München, 80336 Munich, GermanyDepartment of Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Trauma Surgery and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt, 60389 Frankfurt am Main, Germany<b>Background/Objective: </b>This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential consequences, and relate these with different Trauma Team Activation Protocols (TTA-Protocols), as this has not been done before in Germany. <b>Methods</b>: Each trauma center collected the data during a three-month period between December 2019 and February 2021. All 12 participating hospitals are certified as supra-regional trauma centers. Here, we report a subgroup analysis of undertriaged patients. Those included in the study were all consecutive adult patients (age ≥ 18 years) with acute trauma admitted to the emergency department of one of the participating hospitals by the prehospital emergency medical service (EMS) within 6 h after trauma. The data contained information on age, sex, trauma mechanism, pre- and in-hospital physiology, emergency interventions, emergency surgical interventions, intensive care unit (ICU) stay, and death within 48 h. Trauma team activation (TTA) was initiated by the emergency medical services. This should follow the national guidelines for severe trauma using established field triage criteria. We used various denominators, such as ISS, and criteria for the appropriateness of TTA to evaluate the undertriage in four groups. <b>Results</b>: This study included a total of 3754 patients. The average injury severity score was 5.1 points, and 7.0% of cases (<i>n</i> = 261) presented with an injury severity score (ISS) of 16+. TTA was initiated for a total of 974 (26%) patients. In group 1, we evaluated how successful the actual practice in the EMS was in identifying patients with ISS 16+. The undertriage rate was 15.3%, but mortality was lower in the undertriage cohort compared to those with a TTA (5% vs. 10%). In group 2, we evaluated the actual practice of EMS in terms of identifying patients meeting the appropriateness of TTA criteria; this showed a higher undertriage rate of 35.9%, but as seen in group 1, the mortality was lower (5.9% vs. 3.3%). In group 3, we showed that, if the EMS were to strictly follow guideline criteria, the rate of undertriage would be even higher (26.2%) regarding ISS 16+. Using the appropriateness of TTA criteria to define the gold standard for TTA (group 4), 764 cases (20.4%) fulfilled at least one condition for retrospective definition of TTA requirement. <b>Conclusions</b>: Regarding ISS 16+, the rate of undertriage in actual practice was 15.3%, but those patients did not have a higher mortality.https://www.mdpi.com/2077-0383/13/6/1714trauma caretrauma systemsundertriagetrauma team activationfield triage |
| spellingShingle | Helena Düsing Paul Hagebusch Markus Baacke Dan Bieler Michael Caspers Valentin Clemens Matthias Fröhlich Lisa Hackenberg Renè Hartensuer Sebastian Imach Kai Oliver Jensen Annette Keß Christian Kleber Fabian Laue Rolf Lefering Mindaugas Maslauskas Gerrit Matthes André Nohl Orkun Özkurtul Thomas Paffrath Vera Pedersen Tristan Pfläging Kai Sprengel Philipp Störmann Heiko Trentzsch Christian Waydhas Uwe Schweigkofler on behalf of the NIS-Trauma TAcTIC Study Group Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers Journal of Clinical Medicine trauma care trauma systems undertriage trauma team activation field triage |
| title | Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers |
| title_full | Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers |
| title_fullStr | Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers |
| title_full_unstemmed | Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers |
| title_short | Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers |
| title_sort | evaluation of prehospital undertriage in relation to trauma team activation results from a prospective study in 12 level one german trauma centers |
| topic | trauma care trauma systems undertriage trauma team activation field triage |
| url | https://www.mdpi.com/2077-0383/13/6/1714 |
| work_keys_str_mv | AT helenadusing evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT paulhagebusch evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT markusbaacke evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT danbieler evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT michaelcaspers evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT valentinclemens evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT matthiasfrohlich evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT lisahackenberg evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT renehartensuer evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT sebastianimach evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT kaioliverjensen evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT annettekeß evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT christiankleber evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT fabianlaue evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT rolflefering evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT mindaugasmaslauskas evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT gerritmatthes evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT andrenohl evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT orkunozkurtul evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT thomaspaffrath evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT verapedersen evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT tristanpflaging evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT kaisprengel evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT philippstormann evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT heikotrentzsch evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT christianwaydhas evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT uweschweigkofler evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters AT onbehalfofthenistraumatacticstudygroup evaluationofprehospitalundertriageinrelationtotraumateamactivationresultsfromaprospectivestudyin12levelonegermantraumacenters |