gms | German Medical Science

68. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie
90. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie
45. Tagung des Berufsverbandes der Fachärzte für Orthopädie in Zusammenarbeit mit dem Deutschen Verband für Physiotherapie – Zentralverband der Physiotherapeuten/Krankengymnasten

19. bis 23.10.2004, Berlin

In-hospital Downgrading of the Trauma Team: Evaluation of the Downgrading Criteria

Meeting Abstract (DGU 2004)

  • presenting/speaker P. Fung Kon Jin - Academic Medical Center, Trauma Unit, Amsterdam
  • T. van Olffen - Academic Medical Center, Trauma Unit, Amsterdam
  • J. Luitse - Academic Medical Center, Trauma Unit, Amsterdam
  • C. Goslings - Academic Medical Center, Trauma Unit, Amsterdam
  • K. Ponsen - Academic Medical Center, Trauma Unit, Amsterdam

Deutsche Gesellschaft für Unfallchirurgie. Deutsche Gesellschaft für Orthopädie und orthopädische Chirurgie. Berufsverband der Fachärzte für Orthopädie. 68. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 90. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 45. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 19.-23.10.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dguC5-402

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgu2004/04dgu0090.shtml

Veröffentlicht: 19. Oktober 2004

© 2004 Fung Kon Jin et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction

Overtriage of trauma patients is widely accepted in order to minimize undertriage. However, previous studies have shown that this leads to an unnecessary mobilization of the Trauma Team in a high percentage of cases, putting a great burden on the trauma center and leading to an inefficient trauma care. In order to reduce overtriage in our setting, while continuously minimizing undertriage, we developed an in-hospital triage tool with the purpose to reduce the trauma team (downgrading) rather than an upgrade-system as in two- or three-tiered trauma response systems. This study evaluated the implementation of the Downgrading Protocol (DP) and the effect on overtriage rates.

Methods

A prospective study was conducted between July 1st 2002 and December 31st 2002. All trauma patients aged 16 years and older that were admitted to the Shockroom were eligible for inclusion. After conducting the standard ATLS primary survey and the first conventional chest X-ray, the Trauma Team leader decided which composition of the Trauma Team was used. This decision was structured by the DP: a protocol to identify the absence of signs of (potential) severe injury in patients. The list consists of 24 physical and anatomical criteria, including positive signs of injury showing on the initial chest x-ray. Only in the absence of all criteria, the Trauma Team would be reduced. To validate the safety of the DP and its criteria, it was investigated if any of the patients treated by the Downgraded Trauma Team (DTT) were undertriaged by the protocol. All patients that met the Primary Outcome Criteria for a Severely Injured patient and treated by the DTT were deemed undertriaged patients. The effect on overtriage was measured by the percentage of patients treated by a Complete Trauma Team (CTT), while not classified as a Severely Injured patient.

Results

A total of 220 patients were eligible and triaged by the DP. After triage, 95 (43.2%) patients were treated by the DTT while 125 patients were treated by the CTT. In the entire study population, a total of 66 (30.0%) patients met one or more of the Primary Outcome Criteria for a Severely Injured patient. None of these patients were treated by the DTT. Of the 125 patients treated by the CTT, 59 (26.8%) trauma patients were treated while not seriously injured according to the Primary Outcome Criteria.

Conclusions

For the entire study population no undertriage was found, while the implementation of the DP reduced overtriage in the entire study population to 26.8%.

The DP is an efficient and safe way to significantly reduce overtriage in centers that have a similar structure and organization like our center and implementation should lead to a significant increase in efficiency in the Emergency Department.