Survey on worldwide trauma team activation requirement
Authors: Waydhas Christian , Trentzsch Heiko , Hardcastle Timothy C. , Jensen Kai Oliver ,   the World-Trauma TAcTIC Study Group, Abdelmotaleb Khaled Tolba Younes , Abi Saad George , Baacke Markus , Baftiu Nehat , Bartsokas Christos , Becker Lars , Berlusconi Marco Luigi Maria , Bespalenko Artem , Bieler Dan , Brand Martin , Carvalho de Sousa Júnior Edilson , Chotirosniramit Narain , Chung Yuhsuan , Crichton Lesley , De Paepe Peter , Dogjani Agron , Doll Dietrich , Molla Ayene Gebremicheal , Hardcastle Timothy C. , Hardcastle Timothy C. , Haxhirexha Kastriot , Jain Kajal , Jensen Kai Oliver , Korolev Andrey , Zhanfei Li , Lim Jerry K. T. , Linder Fredrik , Lubis Nurhayati , Magnitskaya Nina , MacDonald Damian , Mauser Martin , Matthes Gerrit , Mbugua Kimani , Mlyavykh Sergey , Monzon Barbaro , Togtmol Munkhsaikhan , Mustafa Khreshi , Mwandri Michael , Navsaria Pradeep , Nijs Stefan , Olmedo Francisco , Ortega Gonzalez Maria C. , Fantilli Jesús Palacios , Pirpiris Marinis , Pitance Francois , Pomeroy Eoghan , Sadakah M. A. , Sahoo Tapas Kumar , Saratila Iurie , Scarpelini Sandro , Schweigkofler Uwe , Selmani Edvin , Søderlund Tim , Stein Michael , Thapa Buland , Trentzsch Heiko , Truta Teodora Sorana , Uranues Selman , Waydhas Christian , Wölfl Christoph G. , Yi Sandar Thein , Yovenko Ihor , Zapattini Pablo 
Published: March 2020

Purpose

Trauma team activation (TTA) is thought to be essential for advanced and specialized care of very severely injured patients. However, non-specific TTA criteria may result in overtriage that consumes valuable resources or endanger patients in need of TTA secondary to undertriage. Consequently, criterion standard definitions to calculate the accuracy of the various TTA protocols are required for research and quality assurance purposes. Recently, several groups suggested a list of conditions when a trauma team is considered to be essential in the initial care in the emergency room. The objective of the survey was to post hoc identify trauma-related conditions that are thought to require a specialized trauma team that may be widely accepted, independent from the country’s income level.

Methods

A set of questions was developed, centered around the level of agreement with the proposed post hoc criteria to define adequate trauma team activation. The participants gave feedback before they answered the survey to improve the quality of the questions. The finalized survey was conducted using an online tool and a word form. The income per capita of a country was rated according to the World Bank Country and Lending groups.

Results

The return rate was 76% with a total of 37 countries participating. The agreement with the proposed criteria to define post hoc correct requirements for trauma team activation was more than 75% for 12 of the 20 criteria. The rate of disagreement was low and varied between zero and 13%. The level of agreement was independent from the country’s level of income.

Conclusions

The agreement on criteria to post hoc define correct requirements for trauma team activation appears high and it may be concluded that the proposed criteria could be useful for most countries, independent from their level of income. Nevertheless, more discussions on an international level appear to be warranted to achieve a full consensus to define a universal set of criteria that will allow for quality assessment of over- and undertriage of trauma team activation as well as for the validation of field triage criteria for the most severely injured patients worldwide.