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Correlation of Level of Trauma Activation With Emergency Department Intervention

Cooper, Michael C., MD; Srivastava, Geetanjali, MD, MPH

doi: 10.1097/PEC.0000000000001509
Original Articles

Background In-hospital trauma team activation criteria are formulated to identify severely injured patients requiring specialized multidisciplinary care. Efficacy of trauma activation (TA) criteria is commonly measured by emergency department (ED) disposition, injury severity score, and mortality. Necessity of critical ED interventions is another measure that has been proposed to evaluate the appropriateness of TA criteria.

Methods Two-year retrospective cohort study of 1715 patients from our trauma registry at a Level 1 pediatric trauma center. We abstracted data on acute interventions, level and criterion of TA, ED disposition, and mortality. We report odds ratio (OR) with 95% confidence intervals (CIs), positive predictive value, and frequency of acute interventions.

Results Trauma activation was initiated for 947 (55%) of the 1715 patients. There were 426 ED interventions performed on 235 patients (14%); 67.8% were in level 1 activations; 17.6% in level 2, and 14.6% in level 3. Highest-level activations were highly associated with need for ED interventions (OR, 16.1; 95% CI, 11.5–22.4). The ORs for requiring an ED intervention were low for lower level activations (OR, 0.4; 95% CI, 0.3–0.5), trauma service consults (OR, 0.3; 95% CI, 0.2–0.4), and certain mechanism-based criteria. The ORs for ED intervention for isolated motor vehicle collision (0.2; 95% CI, 0.1–0.7), isolated all-terrain vehicle rollover (0.4; 95% CI, 0.1–1.7), and suspected spinal cord injury (0.5; 95% CI, 0.1–3.7) were significantly lower than 1.

Conclusions Highest-level activation criteria correlate with high utilization of ED resources and interventions. Lower level activation criteria and trauma service consult criteria are not highly correlated with need for ED interventions. Downgrading isolated motor vehicle collision and all-terrain vehicle rollovers and suspected spinal cord injury to lower level activations could decrease the overtriage rate, and adding age-specific bradycardia as a physiologic criterion could improve our undertriage rate.

From the Department of Pediatrics, Division of Emergency Medicine, University of Texas Southwestern; and Children's Health, Dallas, TX.

Presented at the Pediatric Academic Society annual meeting, May 2014, Vancouver, BC, Canada and the Society of Academic Emergency Medicine annual meeting, May 2014, Dallas, TX.

Disclosure: This study was supported by the Department of Pediatrics, University of Texas Southwestern and received no external funding. The authors declare no conflict of interest.

Reprints: Michael C. Cooper, MD, Children's Medical Center, E2.03, 1935 Medical District Dr, Dallas, TX 75235 (e-mail:

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