An evaluation of patient outcomes comparing trauma team activated versus trauma team not activated using TRISS analysis. Trauma and Injury Severity Score.

OBJECTIVE

The purpose of this study was to compare the outcomes of trauma patients with an Injury Severity Score (ISS) > 12 who had the trauma team involved (TTA) in their resuscitative care to those that did not (TTNA).

SETTING

Level I regional trauma center teaching hospital with university affiliation.

METHODS

All trauma patients admitted between July 1, 1991 and August 31, 1994 with an ISS > 12 were identified through the trauma registry. Burn patients, those who suffered their injury > 24 hours before admission, and deaths in the emergency room were excluded from analysis. The TRISS methodology, which offers a standard approval for evaluating outcomes for different populations of trauma patients, was used to determine whether there was a difference in outcomes between the two groups. To include patients who arrived at the trauma center intubated, a Trauma and Injury Severity Score (TRISS)-like analysis was also conducted on this patient population.

MAIN RESULTS

A total of 640 patients were identified; 174 (65.2%) in the TTA group and 223 (34.8%) in the TTNA group. A total of 448 (70%) were eligible for TRISS analysis and 574 (89.7%) were eligible for TRISS-like analysis. Using the TRISS analysis, the TTA group had a Z statistic of 3.36 yielding a W score of 4.27. This compared to the TTNA group whose Z statistic was 0.30. Using the TRISS-like logistic regression equation, the TTA group had a Z statistic of 6.50, yielding a W score of 8.60 compared with the TTNA group whose Z statistic was 0.88. After controlling for differences in the demographics of the two groups, the TTA still had consistently higher Z scores.

CONCLUSION

In a Level I trauma center, the outcomes of trauma patients with an ISS > 12 are statistically significantly better if the trauma team is activated than if the patients are managed on an individual service-by-service basis.