What is optimal timing for trauma team alerts? A retrospective observational study of alert timing effects on the initial management of trauma patients

Figures & data

Table 1 Trauma team activation criteria at St Olav’s University Hospital

Physiological and anatomical criteria

Airway obstruction

Respiratory rate: >29 or <10 breaths/min

Systolic blood pressure: <90 mmHg

Glasgow Coma Scale of <14 and one criterion of mechanism of injury

Severe injury to two or more organ systems

Severe hemorrhage

Flail chest

Dislocated pelvic injury

Fracture to two or more long bones

Penetrating injury proximal to knee/elbow

Traumatic neurological injury

Crush injury/amputation proximal to wrist/ankle

Burns to body surface area of >15% in adults and >10% in children

Increased airway obstruction

Increased abnormal respiration

Increased cyanosis

Mechanisms of injury

Ejection from vehicle

Injury caused by electricity

Pedestrian run over or thrown over vehicle at impact

Children hit by vehicle at >30 km/h

Fall of >5 m, adults

Fall of >3 m, children

Fatality in same vehicle

Entrapment

Roll-over

Vehicle speed of >60 km/h

Vehicle compartment compressed by >30 cm or substantial deformation

Entrapment in avalanche

Hypothermia

Interfacility transfer

Transfer from other hospital within <24 hours of injury

Figure 1 Pre- and in-hospital trauma care process model including definition of time intervals.

Abbreviations: ED, emergency department; LOS, length of stay; TTN, trauma team notification; TTA, trauma team activation; CXR, chest X-ray; ECC, emergency call center.

Table 2 Descriptive statistics from trauma team activations in 2009

Total n = 269	Valid n	Median (minutes)	25-percentile (minutes)	75-percentile (minutes)
From incident to ED	263	76.0	39.0	125.0
From TTN to ED	177	40.7	28.6	62.6
From TTA to ED	268	9.4	6.7	13.0
CXR-time	247	5.0	5.0	7.0
ED LOS	260	25.0	20.0	31.5

Abbreviations: ED, emergency department; TTN, trauma team notification; TTA, trauma team activation; CXR, chest X-ray; ED LOS, length of stay at the emergency department.

Figure 2 Box plots of CXR-times (minutes) for groups of differently timed TTA (minutes).

Notes: *More than three box lengths from the box; °between 1.5–3 box lengths from the box.
Abbreviations: CXR, chest X-ray; TTA, trauma team activation.

Table 3 The effect of trauma team notification

	CXR-time		ED LOS
	≤5 min	>5 min	≤25 min	>25 min
Without TTN	45	38	45	44
With TTN	81	83	91	80
Pearson’s Chi-squared	0.474		0.684
	0 cells (0%) have expected count less than 5. The minimum expected count is 40.66		0 cells (0%) have expected count less than 5. The minimum expected count is 42.45

Abbreviations: CXR, chest X-ray; LOS, length of stay; ED, emergency department; TTN, trauma team notification.

Table 4 The effect of differently timed trauma team activations on CXR-time and ED LOS

	CXR-time		ED LOS
	≤5 min	>5 min	≤25 min	>25 min
TTA–time ≤ 0 min	2	7	6	5
TTA–time 0.01–5 min	8	21	13	13
TTA–time 5.01–10 min	48	49	48	51
TTA–time 10.01–15 min	42	32	41	38
TTA–time 15.01–20 min	21	6	18	14
TTA–time 20 min	5	6	9	3
Pearson’s Chi-squared	0.003		0.649
	2 cells (16.7%) have expected count less than 5. The minimum expected count is 4.41		0 cells (0%) have expected count less than 5. The minimum expected count is 5.27

Abbreviations: CXR, chest X-ray; LOS, length of stay; ED, emergency department; TTA, trauma team activation.

Figure 3 Distribution (%) of last digits in recorded time data.

Notes: Incident, arrival, CXR-time, and departure from ED were recorded manually. TTN and TTA were recorded automatically.
Abbreviations: ED, emergency department; TTN, trauma team notification; TTA, trauma team activation; CXR, chest X-ray.