Sustainable Effectiveness of Applying Trauma Team
Activation in Managing Trauma Patients in
the Emergency Department
Prasit Wuthisuthimethawee MD, FRCST*,
Michael S Molloy MD**, Gregory R Ciottone MD, FCEP**
Affiliation :
* Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Songkhla, Thailand
** BIDMC Fellowship in Disaster Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA 02215, USA
Objective : To determine long term effectiveness of trauma team activation criteria by measuring emergency department
length of stay (EDLOS) and 28-day mortality.
Material and Method: A 3-year retrospective cohort study conducted in adult trauma patients who met one of the trauma
team activation criteria (shock, penetrating torso injury, post traumatic arrest, respiratory rate of less than 12 or more than
30, and pulse rate of more than 120). Specific demographic data, physiologic parameters, EDLOS, injury severity score
(ISS), and 28-day mortality were prospectively recorded into the Trauma Registry database. Multiple logistic regression
analysis was used to determine factors affecting mortality. The Institutional Review Board approval was obtained prior to
undertaking the project.
Results : Two hundred eighty two patients with a mean age of 35.1 years old were eligible. The median ISS was 25 (range,
13-30). The median EDLOS was 85 minutes (range, 50-135) and the 28-day mortality rate was 46.5%. The mean age was
31.7 years in the survival group and 38.7 years in the fatal group (p = 0.001). The median ISS was 17 in the survival group
and 26 in the fatal group (p = 0.000) and the median EDLOS was 110 minutes in the survival group and 82 minutes in the
fatal group (p = 0.034). When compared to data prior to the TTA application, the median time of EDLOS improved sustainably
from 184 to 85 minutes (p = 0.000) and the mortality rate decreased from 66.7% to 46.5% (p = 0.057). The parameters
affecting patient mortality were older age, high ISS, and shorter EDLOS.
Conclusion : Trauma team activation criteria significantly improved acute trauma care in the emergency department and
decreased mortality.
Keywords : Trauma team activation criteria, Emergency room, Trauma
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