Outcomes of patients using a tiered trauma response protocol

Objectives: This study evaluated processes of care and outcome for injured patients at a Level I trauma center who had been either treated as a full t rauma team activation (FULL) or managed with modified trauma team activatio n (MOD). Methods: A retrospective methodology was used to evaluate all patients ente red into the regional trauma system and transported from the scene to a Lev el I trauma center. Patients treated during a 2-year period of exclusively FULL trauma team protocols were compared with patients managed during a sub sequent 2-year period after implementation of a two-tiered response. In the later era, trauma system patients were designated before hospital arrival as either FULL or MOD trauma team responses, An additional case-control ana lysis was conducted on a subset of MOD trauma team response patients who we re undertriaged; that is, in retrospect, they met criteria for a FULL respo nse, The outcomes in the case-control group were compared by x(2) tests and Mann-Whitney U tests. Statistical significance was assumed for p < 0.05. Results: During the presystem period, 1,740 patients were transported as tr auma system entries to Oregon Health Sciences University, During the postsy stem period, 2,333 patients were transported to Oregon Health Sciences Univ ersity as either MOD trauma system entries (1,272 [55%]) or as FULL trauma system entries (1,061 [45%]). Postsystem patients had longer time intervals in the emergency department compared with presystem patients. Death rates for patients who died in the emergency department or before hospital discha rge were similar. Among patients who were designated as MOD trauma system e ntries and were subsequently categorized as meeting FULL trauma team criter ia, mortality rate was low, Conclusion: Implementation of the tiered response protocol led to a substan tial change in the operational response in the emergency department, Althou gh processes of care were nominally prolonged, adverse consequences were no t identified. We concluded from this quality improvement review that implem entation of a tiered response protocol was satisfactory and improved effici ency. Further work is required to improve accuracy of the categorization of trauma system patients as either MOD or FULL trauma codes.