C. Brown1, K. C. Coleman1, A. A. Smith2, J. Bardes1 1West Virginia University, Division Of Trauma, Department Of Surgery, School Of Medicine, Morgantown, WV, USA 2Louisiana State University Health Sciences Center, New Orleans, LA, USA
Introduction: Prehospital tourniquet in place is currently being evaluated for inclusion as a standard criterion for full trauma team activation (TTA) by the American College of Surgeons (ACS) Committee on Trauma (COT). Recent military and civilian literature have shown correctly placed tourniquets in life threatening limb hemorrhage saves lives. Educational campaigns such as STOP THE BLEED have led to an increase in prehospital tourniquet application by both medical and lay rescuers. We intend to evaluate whether using an extended trauma team activation criteria that includes tourniquet application would lead to an unacceptable overtriage rate.
Methods: A multicenter retrospective analysis was performed utilizing the American Association for the Surgery of Trauma (AAST) multi-institutional trial database comparing the standard trauma team activation (S-TTA) against extended trauma team activation (E-TTA). An overtriage analysis was performed using a modified Cribari Method as described in Resources for Optimal Care of the Injured Patient, comparing patients that met standard plus extended criteria to those who met criteria only due to tourniquet placement. Extended criteria included those patients who received a blood transfusion within 4 hours of presentation, procedural intervention within two hours of presentation, had a length of stay 3 days or longer to the intensive care unit, sustained a mortality within three days or had an injury severity score (ISS) > 15.
Results: A total of 1235 patients with tourniquets in place were present in the database. Of which, 484 met the S-TTA criteria with an additional 378 patients having at least one extended criterion. A further 111 patients that initially were considered an overtriage were transitioned to the appropriately triaged group due to having at least one of the following conditions: presence of compartment syndrome, amputation, distal pulses present with a tourniquet in place, subjectively deemed not an effective placement by the surgeon, or a nerve palsy present during hospitalization. This left 262 patients that had only the tourniquet present as full trauma team activation criterion (T-TTA) criteria. An overtriage rate was calculated to be 21.2%.
Conclusion: Prehospital tourniquet application for life threatening hemorrhage as full trauma team activation criterion did not result in an unacceptable overtriage rate. Utilizing this as a criterion for TTA led to an acceptable rate of overtriage of 21%, well within the accepted 25-35% rate. Adding this criterion has the benefit of rapid surgical team evaluation for both intervention in life or limb threatening injuries as well as evaluation for inappropriate or incorrectly placed torniquets which can cause significant morbidity.
