Trauma activation criteria vary from region to region if not trauma center to
trauma center. Triage rules for major resuscitation in a trauma center allow for
prioritization and judicious use of limited resources such as personnel,
equipment, and services. The use of an overly inclusive may cause misuse
limited hospital resources while limited trauma activation criteria may deny
the best medical care to presenting trauma patients. Trauma activation criteria
and guidelines in developing countries, particularly in the Middle East and
Lebanon have not been previously described nor validated.
This retrospective study was conducted in the ED at the American
University of Beirut Medical Center (AUBMC). AUBMC is the largest academic
tertiary care center in Lebanon and is a major local and regional referral
center. In 2012, the ED and trauma department formed a taskforce to implement a
trauma response protocol for patients arriving with suspected major trauma. The
protocol included introducing and training staff on trauma team activation
criteria. The CDC prehospital field triage criteria were adopted with minor
modifications.
This study examines the performance of Emergency
Department (ED) based TA criteria with respect to important clinical outcomes in
a tertiary care center in Lebanon.
Variables that were collected included patient demographics, ED arrival
method, trauma activation status, Emergency Severity Index (ESI) (ranging from
1 to 5, most to least urgent), injury details and Injury
Severity Score (ISS), imaging modalities and surgical procedures, blood
transfusion status, ED and hospital dispositions and cause of death. Selected outcomes
variables were clinical (ISS and mortality) and resource utilization (Blood Product
Transfusion (BPT), need for imaging (Computed Tomography:
CT, X-ray), surgical procedures and Intensive Care Unit (ICU) admission).
This retrospective study was conducted in the ED at the American University of Beirut Medical Center (AUBMC). AUBMC is the largest academic tertiary care center in Lebanon and is a major local and regional referral center.
A chart review was conducted on patients of all age groups presenting
with any type of trauma (coded in the ED electronic health records system as separate
variables) who died in the ED or were hospitalized during a one-year period
(July 1, 2016 – July 1, 2017).
A chart review was conducted on patients of all age groups presenting with any type of trauma (coded in the ED electronic health records system as separate variables) who died in the ED or were hospitalized during a one-year period (July 1, 2016 – July 1, 2017).
Patients with missing or incomplete charts were excluded.
Patients who were discharged from ED or transferred to other hospitals were
also excluded because of missing in-hospital course.