Evaluation of trauma team activation criteria in Germany. A retrospective analysis of 94.000 cases from the TraumaRegister DGU®.

Abstract

Effective trauma triage relies on accurate trauma team activation (TTA) criteria to balance resource allocation and patient outcomes. Current guidelines prioritize high-risk of severe injury (HRSI) criteria, while moderate-risk of severe injury (MRSI) criteria are associated with high over-triage rates. Using data from the TraumaRegister DGU® (TR-DGU), this study evaluates the impact of different TTA criteria on patient outcomes and trauma system efficiency. A retrospective cohort study was conducted using TR-DGU data from 2018 to 2023, including patients aged ≥16 years with trauma team activation, emergency room treatment, and intensive or intermediate care admission. Patients were categorized based on TTA criteria: HRSI, MRSI, or provider decision ("None"). Injury severity, mortality, emergency interventions, intensive care unit (ICU) stay, and hospital length of stay were analyzed. Statistical comparisons utilized chi-square and Mann-Whitney-U tests, with significance set at p < 0.05. The final cohort included 97,295 patients: 42 % met HRSI criteria, 38 % MRSI, and 20 % were assigned due to provider decision. Patients in the HRSI group had the highest injury severity (ISS=23.5), mortality (19.3 %), and need for emergency interventions (31 %). In contrast, the MRSI group had significantly lower severity (ISS=12.5), mortality (1.6 %), and intervention rates (13 %). The "None" group, comprising mostly elderly patients with ground-level falls, had a higher mortality rate (8.5 %) despite a comparable ISS (13.5). Findings highlight the limitations of MRSI-based TTA criteria, which contribute to resource overutilization without improving patient outcomes. A tiered activation strategy prioritizing HRSI while refining MRSI criteria may enhance triage efficiency. The high mortality rate in the "None" group suggests the need for additional triage parameters, particularly for geriatric patients. These insights support recent guideline revisions and are the basis for further evaluations.