Optimization of criteria for activation of trauma teams : Avoidance of overtriage and undertriage

• Published in: Der Unfallchirurg Vol. 121; no. 10; pp. 788 - 793
• Main Authors: Bieler, D, Trentzsch, H, Baacke, M, Becker, L, Düsing, H, Heindl, B, Jensen, K O, Lefering, R, Mand, C, Özkurtul, O, Paffrath, T, Schweigkofler, U, Sprengel, K, Wohlrath, B, Waydhas, C
• Format: Journal Article
• Language: German
• Published: Germany 01-10-2018
• Subjects: Germany; Health Care Rationing - standards; Humans; Patient Care Team - standards; Patient Selection; Prospective Studies; Quality of Health Care - standards; Registries; Trauma Centers - standards; Triage - standards; Germany; Health resources; Patient safety; Registries; Triage; Polytrauma
• ISSN: 1433-044X
• DOI: 10.1007/s00113-018-0553-0

Severely injured patients are supposed to be admitted to hospital via the trauma room. Appropriate criteria are contained in the S3 guidelines on the treatment of patients with severe/multiple injuries (S3-GL); however, some of these criteria require scarce hospital resources while the patients then often clinically present as uninjured. There are tendencies to streamline the trauma team activation criteria (TTAC); however, additional undertriage must be avoided. A study group of the emergency, intensive care medicine and treatment of the severely injured section (NIS) is in the process of optimizing the TTAC for the German trauma system.
In order to solve the objective the following multi-step approach is necessary: a) definition of patients who potentially benefit from TTA, b) verification of the definition in the TraumaRegister DGU® (TR-DGU), c) carrying out a prospective, multicenter study in order to determine overtriage and undertriage, thereby validating the activation criteria and d) revision of the current TTAC.
This article summarizes the consensus criteria of the group assumed to be capable of identifying patients who potentially benefit from TTA. These criteria are used to test if TTA was justified in a specific case; however, as the TTCA of the S3-GL are not fully incorporated into the TR-DGU dataset and because cases must also be considered which were not subject to trauma room treatment and therefore were not included in the TR-DGU, it is necessary to perform a prospective full survey of all individuals in order to be able to measure overtriage and undertriage.
Currently, the TR-DGU can only provide limited evidence on the quality of the TTAC recommended in Germany. This problem has been recognized and will be solved by conducting a prospective DGU-supported study, the results of which can be used to improve the TR-DGU dataset in order to enable further considerations on the quality of care (e. g. composition and size of the trauma team).