The Efficacy of a Two-Tiered Trauma Activation System at a Level I Trauma Center

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By using current American College of Surgeons trauma center triage criteria, 52% of patients transported to our level I trauma center are discharged home from the emergency department (ED). Because the majority of our trauma transports were based solely on mechanism of injury, we instituted, in 1990, a two-tiered trauma team activation system. Patients are triaged into major and minor trauma alert categories based on prehospital provider information. For minor trauma patients, respiratory therapy, operating room staff, and blood bank do not respond. The current study evaluated this triage system.


Trauma registry data on all trauma activations from 1998 to 2007 were analyzed.


There were 20,332 trauma activations: 5,881 were major trauma, 14,451 minor trauma. The mean Injury Severity Score in major versus minor patients was significantly different (11.7 vs. 3.6, p < 0.0001). Significant differences (p < 0.0001) were also noted for all other markers of serious injury: Injury Severity Score >16, ED blood pressure <90, Glasgow Coma Score ≤12, ED intubation, disposition directly to the operating room or the intensive care unit, and death. There were 19 deaths (0.13%) in the minor trauma group, all occurring after hospital admission. All these patients were seen in the ED by the attending trauma surgeon. Two patients were mistriaged. The remaining 17 deaths were due to progression of brain injury in 10 patients, preexisting medical conditions in 4, delayed diagnosis of blunt intestinal injury in 1, delayed aortic rupture in 1, and papillary muscle rupture in 1.


A two-tiered trauma activation system identifies patients who require a full trauma team response and may result in a more effective use of trauma center resources.

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