L. M. Maloney1, E. C. Huang1, A. J. Singer1, R. C. Jawa1 1Stony Brook University Medical Center,Stony Brook, NY, USA
Introduction: Most trauma centers have two levels of trauma team activation based on physiologic, anatomic, or mechanistic criteria: full activation (Code T), and partial activation (Trauma Alert).
Methods: A query was performed on a pre-existing, ACS verified level 1 trauma center registry for Code T or Trauma Alert patients. Inclusion criteria included: presentation between 1/1/2015 and 12/31/2017, hospital admission, age >16 years. Exclusion criteria included death in the ED and isolated burns. Univariate statistical analyses were performed to compare baseline characteristics and outcomes in patients in these two groups.
Results: Of 5023 trauma admissions, 314 were after a Code T, and 571 after a Trauma Alert. No large differences existed in sex (75% vs 73% male), median age (41[IQR 25-58] vs 45[IQR 26-73] years), or percentage of patients with ?1 comorbidity (59% vs 60%, p=.769). Trauma Alerts most often had ?5 comorbidities (3% vs 0%, p=.003), and were more likely to have diabetes (9% vs 3%, p=.003), dementia (4% vs 0.6%, p=.009), and a pre-admission DNR (2% vs 0%, p=.009). The most common mechanism of injury was motor vehicle/motorcycle collisions in both groups (43% Code T vs 48% Trauma Alert, p=0.15). Code T patients were more likely to sustain penetrating injuries (16% vs 2%, p<0.001), while Trauma Alert patients were more likely to sustain a fall (25% vs 16%, p=.004). Code T patients more often had major injuries (AIS>3) to the head (31% vs 16%, P<0.001), c-spine (7% vs 3%, p=.008), chest (45% vs 22%, p<0.001), and abdomen (17% vs 8%, p<0.001). Code T patients had a median ISS of 19 (IQR 9-33), compared to a median ISS of Trauma Alert patients of 10 (IQR 5-17, p<.001). The median ED GCS was 14 (IQR 3-15) for Code T patients and 15 (IQR 15-15, p<.001) for Trauma Alert patients. Disposition following evaluation in the ED was more often to the ICU in Code T patients (35% vs 25%, p=.003), and to the Operating Room (46% vs 25%, p<.001). Code T patients more often received blood within 4 hours of arrival (34% vs 7%, p<.001). Code T patients more often had complications (20% vs 10%, p<.001), with the most likely being a PE/DVT (5% vs 2%, p=.042) or ulcers (3% vs 0.7%, p=.01), with similar percentages of pneumonia, AMI, sepsis, respiratory or failure, stroke, and unplanned ICU time. The final disposition at hospital discharge of Trauma Alert patient was more frequently home than Code T patients (66% vs 48%, p<.001). Code T patients had a higher mortality rate (14% vs 2%, p<.001).
Conclusions: The data demonstrate the principles of trauma triage recommended by the ACS effectively identified high-risk patients at the only level 1 trauma center in a large suburban county
