Implementation of New Trauma Triage Criteria and Implications on Under- and Overtriage.

Study Overview
=================
Brief Summary
-----------------
New trauma alert criteria has been introduced in Sweden, and our aim in this study is to evaluate the outcome of the old and new trauma alert criteria in a cohort of 1.300.000 inhabitants at six hospitals regarding over- and undertriage and number of alerts initiated. The Swedish trauma registry is used to identify eligible patients.

Detailed Description
-----------------
The Swedish trauma registry (SweTrau) was initiated in 2011, and has up to date 40.000 registered patients. In order to evaluate trauma alert criteria implemented during 2017, we plan a prospective stepped wedge trial at six hospitals in the Uppsala/Örebro region. These hospitals register in SweTrau and all had the same alert criteria prior to the implementation of new alert criteria. A power estimation show the need for 588 patients in each group in order to show a statistical difference between 2-5% undertriage at a 95% CI. The including hospitals has a population base of 1.300.000 inhabitants, and the annual number of trauma alerts has been about 3.000. The registry has information about time of trauma, initiated alerts, Injury Severity Score and mechanism of injury suitable for analysis for our hypothesis.

Official Title
-----------------
Implementation of New Trauma Triage Criteria and Implications on Under- and Overtriage

Conditions
-----------------
Trauma Injury

Intervention / Treatment
-----------------
* Diagnostic Test: Implementation of new alert criteria


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: - All patients registered in SweTrau at all including sites between 1 June 2016 and 1 November 2017 Exclusion Criteria: Patients registered due to secondary referral where the initial assessment was performed at another hospital
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Prior alert criteria<br>Patients who activated full, limited or no alert criteria according to the prior alert criteria | Diagnostic Test: Implementation of new alert criteria<br>* The intervention is when the prior alert criteria are replaced by the present alert criteria<br>|
| Present alert criteria<br>Patients who activated full, limited or no alert criteria according to the present alert criteria | Diagnostic Test: Implementation of new alert criteria<br>* The intervention is when the prior alert criteria are replaced by the present alert criteria<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of alerts initiated | The total number of trauma alerts initiated in the study group | One year data with intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Analysis of over- and undertriage with the Matrix method | Analyse proportions of patients subject to a full trauma team activation who have an injury severity score <15 (overtriage). Analyse proportion of patients who do not initiate a full trauma team activation but have an injury severity score >15 (undertriage) The Matrix method is a well defined method for analysing resource allocation in trauma triage. | One year data with intervention |