An Analysis of Trauma Team Activations at a South African Level One Trauma Centre

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Abstract
Introduction: South Africa has a high prevalence of trauma causing a significant healthcare and financial burden. Various scoring systems have been developed to guide trauma team activation (TTA). To date, however, there are no standardised criteria for TTA. The aim of this preliminary study was to analyse the practice of clinical judgement TTA when compared to the American College of Surgeons Committee on Trauma (ACS-COT) TTA guideline and the Loma Linda Rule for TTA. Methods: This was a retrospective analysis of trauma registry data over a one-year period from a Level 1 trauma centre in South Africa. Results: There were 9207 trauma patients that presented to the Emergency Department during the 1-year study period. The prevalence of trauma team activation by clinical judgement was 9.4%. Only 407 patients (48%) of the clinical judgement TTAs fulfilled the ACS-COT guidelines for TTA. Using the Loma Linda Rule, 456 patients (53.8%) of the clinical judgement TTAs fulfilled TTA criteria. Despite the over-triage by the clinical judgement TTA, almost two-thirds of the TTA patients were admitted to the intensive care or high care units. Conclusions: This preliminary study showed that TTA using healthcare provider clinical judgement resulted in trauma team over-activation when compared to the ACS-COT guideline and the Loma Linda Rule. Over-activation of the trauma team consumes valuable resources and potentially endangers those patients who actually need TTA and cannot receive it. Implementation of a standardised TTA tool could potentially aid in the optimisation of patient care and appropriate resource utilisation.

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