Andrew Mekhail, Intensive Care Registrar, Wellington Regional Hospital, NZ
Andrew Mekhail is a PGY4 registrar at Wellington Hospital who has just completed a rotation in Intensive Care Medicine with the aim of pursuing a career in surgery. He has always had an interest in trauma because of the multiple organ systems that must be managed simultaneously. One way of improving care for those presenting with traumatic injuries is the use of scoring systems to streamline imaging and treatment by mobilising appropriate medical staff and services. Andrew looks at and analyses the use of 2 different scoring tools to investigate their efficacy in the management of patients presenting with major traumatic injuries.
Integrating the “Trauma Code Crimson” (TCC) Score to Wellington Emergency Department to Help Recognise and Facilitate Early Intervention for Patients Presenting with Exsanguinating Truncal Injuries
Mekhail, A., Intensive Care Medicine Registrar, Wellington Hospital, New Zealand Moore, J., Intensive Care Specialist, Cardiac Anaesthetist, Head of Trauma, Wellington Hospital, New Zealand
Introduction: Major trauma with exsanguinating injury is a large contributor to morbidity and mortality, particularly in young and usually healthy populations. Treatment is time critical with trauma calls and blood product transfusions not adequate in themselves to manage these injuries. The “Trauma Code Crimson” (TCC) score aims to recognise these patients based on clinical signs. A score of 1 is allocated for each; penetrating injury, systolic blood pressure<90mmhg, heart rate>120bpm, E-FAST positive for free fluid. Scores 2 or greater would activate the TCC and urgent senior surgical review requested allowing for early mobilisation of surgical or interventional radiology (IR) teams.
Aim: To see if the proposed TCC score accurately identifies those with truncal exsanguinating injuries who would benefit from early senior surgical review.
Method: Data from major trauma presentations to Wellington Emergency Department (ED) from 1/January/2020 till 31/December/2020 was gathered. Each presentation was analysed to see if they met criteria to score 2 or more on the TCC. Presentations that met criteria were analysed further to identify if these patients required emergent IR/surgical intervention or activation of the Massive Transfusion Protocol (MTP).
Results: There were a total of 176 major trauma presentations to ED from the study period. Of these only 7 presentations scored 2 or more by the TCC criteria. From those 4 required activation of the MTP, and 4 required acute intervention with IR or emergent surgery. General surgical teams were most often the admitting team with 5 admissions and orthopaedic surgery admitting the remaining 2 patients. Triggering the TCC had a PPV of 0.57 for acute surgical or IR intervention.
Conclusion: The TCC accurately identifies those with significant truncal haemorrhagic injuries and these high risk patients would likely benefit from early senior surgical review. The majority of cases identified by the TCC required acute surgical/IR intervention.