Optimization of Trauma Care: A Two‑tiered Inhospital Trauma Team Response System

Document Type : Original Article


Departments of Trauma Surgery and 1Emergency Medicine, VU University Medical Center, Amsterdam, The Netherlands



Background: To improve utilization of resources and reduce overtriage, two‑tiered trauma team activation (TTA) system was implemented.
The system activates a complete or selective trauma team (CTT, STT). Activation is based on the mechanism of injury (MOI), prehospital vital
signs and injuries. Objectives: The objective was to evaluate the feasibility, effectiveness and safety of the implementation of a two‑tiered
system and whether the triage is done according to the TTA criteria. Methods: A prospective observational study was performed at the
emergency department (ED) of a Level I trauma center. Data were collected on TTA criteria, patient demographics, MOI, prehospital vital
signs, imaging modalities and blood gas analysis in the ED and inhospital data. Results: In 3 months, 186 patients were presented to the trauma
resuscitation room. Thirty‑four patients were excluded, 152 patients were included for analysis. Median age was 48 years (range 1–93), 64%
were males. In 73%, the CTT was activated, in 27% the STT, the STT was upgraded three times. Seventy‑nine patients had to be admitted,
the median length of stay was 5 days (range 1–62). Thirty‑eight patients needed Intensive Care Unit (ICU) admission; the median ICU stay
was 3 days (range 1–33). Three patients died in the resuscitation room, in total, nine patients died. Overtriage was 29% and undertriage 7%.
No significant difference was found for mortality, duration of hospital admission or ICU admission across the four groups (correct activation
STT, undertriage, overtriage, and correct activation CTT). Conclusions: This TTA system identifies those patients in need of a CTT adequately
with an undertriage percentage of 7%, indicative of improved care for the severely injured and a more appropriate use of resources. With this
model, the overtriage is set to an acceptable percentage of 29%.


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