1. Introduction/Abstract Background: In-hospital trauma team activation criteria are formulated to identify severely injured patients needing specialized, multidisciplinary care. Efficacy of trauma activation (TA) criteria is commonly measured by emergency department (ED) disposition (intensive care unit admission, immediate operative management), Injury Severity Score, and mortality. Necessity of critical ED interventions is another measure that has been proposed to evaluate the appropriateness of TA criteria. Purpose: To benchmark ED intervention as an additional measure to evaluate the effectiveness of the TA criteria. Our aim was to identify opportunities to refine TA criteria to be resource-sensitive without affecting patient safety. Correlation of Level of Trauma Activation with Emergency Department Intervention Michael C. Cooper, MD, Third Year Pediatric Emergency Medicine Fellow, Geetanjali Srivastava, MD MPH The University of Texas Southwestern, Children’s Medical Center Dallas Results Level 1, “STAT” criteria: high correlation with ED intervention, ICU admission, operative management (<4 hours), and mortality Level 2, “Alert” criteria: low correlation with ED intervention Level 3, “Evaluation” criteria: low correlation with ED intervention Physiologic criteria: high correlation with ED intervention Bradycardia is not a current criterion, but has high OR for ED intervention. Certain mechanism-based criteria (rollover motor vehicle collision, all terrain vehicle rollover): low correlation with ED interventions. Description of study/Methods Study design: 2-year retrospective descriptive cohort study of patients from our pediatric trauma registry Study setting: Level 1 pediatric trauma center Data abstracted: Patient demographics, acute interventions, level and criterion of trauma activation, ED disposition, and mortality Data analysis: Odds ratio (OR) with 95% confidence intervals, positive predictive value, and frequency of acute interventions Conclusions Level 1 “STAT” criteria are correlated with high utilization of ED resources and interventions. Level 2 “Alert” criteria and trauma evaluation are not correlated highly with need for ED interventions. Eliminating MVC rollover and ATV rollover criteria could decrease the overtriage rate. Adding bradycardia as a physiologic criterion could improve our undertriage rate. References 1. American College of Surgeons – Committee on Trauma. Resources for Optimal Care of the Injured Patient. Chicago, IL. American College of Surgeons. 2006. 2. Centers for Disease Control and Prevention. MMWR. Guidelines for Field Triage of Injured Patients. Recommendations of the National Expert Panel on Field Triage, 2011. Jan 13, 2012. 3. Falcone, R. et al. A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons. EAST 2012 Plenary Paper. J Trauma Acute Care Surg. 2012.; 73 377-384. 4. Krieger, A, et al. Efficacy of anatomic and physiologic indicators versus mechanism of injury criteria for trauma activation in pediatric emergencies. J Trauma Acute Care Surg. 2012. 73. 1471-1477. Texas Pediatric Society Electronic Poster Contest Table 1. A. Patient demographic information B. Clinical and outcome characteristics ANumberPercent Trauma cohort 7/1/10-6/30/11 7/1/11-6/30/12 1715 846 869 49 51 Gender – male107062 Mean Age Range Standard deviation 6.2 yrs 3 d-17 yrs 4.5 yrs Age distribution < 1 year 1-4 years 5-9 years 10-14 >14 years 230 502 493 460 30 13 29 27 2 Race Black Hispanic White Unknown/Other 384 642 626 63 22 37 4 BNumberPercent Injury Severity Score Minor (1-8) Moderate (9-15) Severe (16-24) Very Severe (>24) 946 422 202 145 55 25 12 8 Disposition ED discharge Admit to surgical service Transfer to OR Admit to ICU Transfer to burn center 386 855 177 291 6 23 50 10 17 <1 Trauma team activations Level 1 "STAT" Level 2 "Alert" Level 3 "Evaluation" 947 208 739 768 55 12 43 45 ED Interventions (patients) Level 1 "STAT" Level 2 "Alert" Level 3 "Evaluation" 235 125 59 51 14 53 25 22 Operative Management < 4 hours > 4 hours 326 131 195 19 40 60 Mortality ED OR or ICU 50 15 35 3 30 70 Table 1. N = 171 5 (%) ED Inter- vention PPV ED Inter- vention OR (95% CI) ICU Admit OR (95% CI) Overall Mortality OR (95% CI) Trauma Activation 947 (55 %) 20% 2.5 (1.9- 3.4) 4.0 (2.9- 5.4) 13.6 (4.2- 43.9) Level 1 “STAT” 208 (12 %) 60% 16.1 (11.5- 22.4) 14.3 (10.3- 19.8) 109.7 (39.0- 308.4) Level 2 “Alert” 739 (43 %) 8% 0.4 (0.3- 0.5) 0.7 (0.5- 0.9) 0.03 (0.0- 0.18) Trauma Evaluation 768 (45 %) 6% 0.3 (0.22- 0.41) 0.25 (0.18- 0.34) 0.07 (0.02- 0.24) Figure 1. Odds Ratio of ED Intervention by Activation Criterion CI: confidence interval, PTA: prior to arrival, MVC: motor vehicle collision, ATV: all- terrain vehicle, MPC: pedestrian struck by motor vehicle, MBC: bicyclist struck by motor vehicle. * trauma stat criteria, # trauma alert criteria Figure 2. Type & Frequency of ED Intervention by Level of Activation There were 420 interventions performed on 235 patients. Table 2. Odds ratios (OR) and positive predictive values (PPV) for ED intervention, ICU admission, and mortality by activation status