D. Kim1, A. Lai1, S. Lorch1, C. Kapsalis1, D. Ciesla1 1University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction:
The trauma resuscitation team (TRT) adds to the care of the injured by performing immediately life saving interventions, completing the diagnostic workup, and planning definitive care. Triage guidelines target TRT activation to those patients who are at high risk of severe injury. Ground level fall (GLF) is the most common mechanism associated with injury related hospital discharges. Although GLF is a low energy transfer mechanism, patients often present with physiologic findings that trigger TRT activation. The purpose of this study was to measure the need for life saving interventions in patients presenting after ground level falls.
Methods:
We queried our institutional trauma registry for all patients presenting after ground level fall from 2012-2014. Records were reviewed to determine the number of life saving interventions that occurred during the initial treatment phase. Life saving interventions were defined as CPR, intubation, chest tube placement, central line placement, packed red blood cell transfusion and transfer directly to the OR. Patients were grouped according to TRT Activation (full), Alert (partial), consult or none.
Results:
We identified 1398 patients who suffered ground level falls. Only 0.1% of patients underwent CPR in the ER. Intubation was required in 4.2% of all patients. Of the 59 patients that required intubation, 36 were intubated in the pre-hospital setting. Other life saving interventions included chest tube placement in 0.5% of patients, central line placement in 0.8% of patients, packed red blood cell transfusion in 1.1% of patients and transfer directly to the OR in 5.4% of patients.
Of those who were transferred directly to the OR, 12 required decompressive craniotomies. Operative fixation of fractures occurred in 55 patients. Laminectomy with fusion was required in 2 patients. Ophthalmic injuries necessitating operative intervention occurred in 7 patients. No patients required a trauma laparotomy.
Conclusion:
The main value of a trauma team is to perform life saving interventions and to approach the injured patient in an organized fashion. Patients who suffer from ground level falls rarely require life saving interventions. Trauma triage is a dynamic process. In a setting where patients can be rapidly evaluated and their triage upgraded at any time, the best use of resources may be to forgo pre-hospital trauma team activation for the ground level falls.
