Assessing the rates of overtriaging with prehospital trauma team activation protocols.

Abstract

Introduction: Prehospital trauma team activation protocols are increasingly used to expedite clinical care and potentially improve patient outcomes. However, there is little evidence describing the rates of overtriaging following prehospital activation.

Methods: In June 2018, prehospital trauma team activation protocols were implemented at the Ottawa Hospital. We conducted a health records review of all adult trauma team activations at this Lead Trauma Hospital from September 2016 to March 2020. Cases were prospectively recorded in the regional trauma registry. Pre-implementation and post-implementation cohorts were divided based on the implementation date of the local activation protocols. Overtriaging rates were compared between both groups. We defined overtriaging as activating the trauma team without any of the following: death, ≥ 48-h admission, intensive care unit admission, operative management, or an injury severity score ≥ 16. We present descriptive statistics with odds ratios and 95% confidence intervals to describe the rates of overtriaging.

Results: We analyzed 762 trauma team activations with 384 in the pre-implementation group and 378 in the post-implementation group. The frequency of prehospital trauma team activation was 25.3% (N = 97) in the pre-implementation period, compared to 47.6% (N = 180) in the post-implementation period. There was no statistically significant increase in overtriaging when comparing the pre-implementation (N = 64, 16.7%) and post-implementation (N = 68, 18.0%) groups (OR 1.10; 95% CI 0.75, 1.60). Furthermore, the rate of overtriaging for each individual criterion of the local protocol adhered to guideline recommendations (< 25-35%). Lastly, in the post-implementation period, there was no significant difference in overtriaging with prehospital (N = 30, 16.7%) compared to in-hospital (N = 38, 19.2%) trauma team activation (OR 0.84; 95% CI 0.50, 1.43).

Conclusion: Our study demonstrates that the local prehospital trauma team activation protocol did not result in a statistically significant rise in overtriaging. These findings demonstrate that implementing center-specific prehospital trauma team activation protocols did not increase overtriaging rates.