Evaluating Delivery of Trauma-Informed Care in the Trauma Bay.

Abstract

Trauma-informed care (TIC) is an approach that promotes patient safety, dignity, and agency within the clinical environment and has recently been incorporated into Advanced Trauma Life Support recommendations. To characterize how TIC principles are applied during the initial evaluation of injured patients in the trauma bay and to assess whether TIC delivery differs between English-speaking patients and Spanish-speaking patients. This cross-sectional study analyzed audiovisual recordings from trauma assessments at 6 level I trauma centers enrolled from March 2024 to April 2025. Patients were included if they were alert, hemodynamically stable (systolic blood pressure >90; heart rate <120), and had a Glasgow Coma Scale score greater than 13. Data were analyzed from August to November 2025. A standard checklist was used to assess basic communication (eg, introductions), empathetic communication (eg, reassurances), and comprehensiveness of the examination. Differences in these elements were compared between English- and Spanish-speaking patients using χ2, t tests, and Wilcoxon rank sum analyses. A total of 291 patient encounters (median [IQR] age, 41 (28-63) years; 162 male [55.7%]) were reviewed. The median (IQR) Injury Severity Score was 9 (1-14), and 216 encounters (74.6%) were for blunt injuries. There were 236 English-speaking patients (81.1%), 52 Spanish-speaking patients (17.9%), and 17 patients (32.7%) had an interpreter present for any part of the evaluation. A physician introduced themselves in 74 encounters (28.8%), less often for Spanish-speaking patients than English-speaking patients (3 of 49 encounters [6.1%] vs 71 of 208 encounters [34.1%]; P < .001). Nurse introductions occurred in 26 encounters (10.0%). Spanish-speaking patients, compared with English-speaking patients, received fewer verbal reassurances (median [IQR], 1 [0-1] vs 2 [1-4] assurances; P < .001) and were less likely to be given at least 1 physical reassurance (7 of 51 encounters [13.7%] vs 118 of 229 encounters [51.5%]; P < .001). Approximately half of patient interventions included any communication (mean [SD], 55.4% [29.5 percentage points]), with lower rates for Spanish-speaking patients than English-speaking patients (mean [SD], 46.5% [28.8 percentage points] vs 57.3% [29.4 percentage points]; P = .02). Few patients (97 [34.2%]) had complete physical examinations, and this was less frequent for Spanish-speaking patients than English-speaking patients (7 [13.7%] vs 90 [38.6%]; P < .001). This cross-sectional study found that TIC practices, including fundamental communication, empathetic engagement, and patient-centered behaviors, were inconsistently delivered during acute trauma resuscitation. Spanish-speaking patients experienced lower rates of trauma-informed communication and were less likely to receive a complete examination. Improving the quality and equity of trauma care will require deliberate integration of trauma-informed principles into trauma education, performance improvement, and clinical practice.