Efficiency of activation of the trauma team in a Norwegian trauma referralcentre

Objective: To evaluate the efficiency (sensitivity, specificity, positive p redictive value, overtriage, and undertriage) of activation of the trauma t eam in a Norwegian trauma referral centre. Design: A cohort study with univariate and multivariate analysis. Setting: A primary trauma hospital and trauma referral centre Norway. Subjects: 3391 injured patients admitted during a 12 months period, startin g January 15th, 1990. Main outcome measures: Activation of the trauma team for severely injured p atients and factors associated with correct activation. Result: Of the 3383 injured patients admitted, 283 (8%) were classified as severely injured. Of 507 activations of the trauma team. 240 (47%) were for severely injured patients (sensitivity 85%, undertriage 15%. specificity 9 1%, overtriage 9%, positive predictive value 0.47). The system of activatio n was significantly more efficient for patients admitted by anaesthetist-ma nned ambulances than by ordinary ground ambulances (sensitivity 94% compare d with 83%, corresponding positive predictive value 0.55 and 0.33. p < 0.05 ). Female sex and age over 70 years were independent factors associated wit h significantly less use of the trauma team in severely injured patients (p < 0.05). Conclusion: The undertriage rate of 15% and a positive predictive value of only 0.47 indicates a need for improvement of our activation system. Female sex and age over 70 years were significantly associated with undertriage i n severely injured patients. Our protocol for triage and the initial treatm ent of severely injured patients has been revised in the light of these fin dings, and we have established a trauma registry.