Trauma Team Activation in Christchurch Hospital
Nonis, M. University of Otago, Christchurch, New Zealand McCombie, A. Canterbury District Health Board, Christchurch, New Zealand Wakeman, C. University of Otago, Christchurch, New Zealand and Canterbury District Health Board, Christchurch, New Zealand Fleischer, D. Canterbury District Health Board, Christchurch, New Zealand Evans, M. Canterbury District Health Board, Christchurch, New Zealand Joyce, L. University of Otago, Christchurch, New Zealand and Canterbury District Health Board, Christchurch, New Zealand
Introduction: New Zealand defines major trauma as injury severity score >12. Christchurch Emergency Department (ED) uses a two-tier Trauma Team Activation (TTA) system, with a “trauma call” for the most seriously injured patients, and “trauma standbys” for those less injured, with less staff required to attend.
Aims: To observe differences in key performance indicators for major trauma patients with a TTA, versus patients without, and review of whether trauma calls and standbys had different outcomes.
Methods: A retrospective observational study of major trauma patients presenting to Christchurch ED 1st June 2018 to 31st May 2019.
Results: 427 patients were included in the study, 267 had a TTA (195 were trauma calls and 27 trauma standbys).
Patients <65 (OR 8.10, 95%CI: 3.07-21.34) and Asians were more likely to have a TTA (OR 2.84 95%CI: 1.27-6.36). Patients with a TTA had shorter time to CT (94.7 v 228mins p <0.001), longer hospital length of stay (LOS) (13.7 v 6.0days, p <0.001) and more likely to be admitted to ICU (OR 6.59, 95%CI: 3.68-11.82). ED LOS was shorter for TTAs (3.6 v 6.0hrs, p <0.001), however ICU LOS was longer (10.9 v 3.9days, p <0.001). Patients with a TTA were less likely to die (OR 0.46, 95%CI:0.24-0.87), but more likely to require surgery (OR 2.83, 95%CI: 1.89-4.25).
There was no significant difference in mortality between trauma calls and standbys (OR 3.34, 95%CI: 0.75-14.85), but ED and ICU LOS was longer for those with a trauma standby.
Conclusion: Trauma team activation resulted in lower mortality, shorter ED LOS and time to CT/OT. Patients over 64 years were less likely to have a TTA, suggesting an under-appreciation of their injuries.
Trauma standbys had similar mortality to full trauma calls, and further investigation may assess the cost-benefit of the full interprofessional trauma team attending major trauma patients.