1. Do trauma teams make a difference? A single centre registry study Timothy H. Rainer, N.K. Cheung, Janice H.H. Yeung, Colin A. Graham

2. Objective To evaluate the association between trauma team activation according to well-established protocols and patient survivalTo evaluate the association between trauma team activation according to well-established protocols and patient survival

3. Materials and Methods Emergency department of the Prince of Wales Hospital between Jan 2001 and Dec 2005Emergency department of the Prince of Wales Hospital between Jan 2001 and Dec 2005 First responseFirst response Three emergency physicians and three nursesThree emergency physicians and three nurses Second responseSecond response Response to “trauma call”Response to “trauma call” Two general surgeons, an orthopaedic surgeon and ICU physicianTwo general surgeons, an orthopaedic surgeon and ICU physician

4. Trauma call activation criteria If any single criteria was met then a trauma call should be activated

5. Materials and Methods Correct callCorrect call Activation of the trauma call when indicated according to predetermined guidelinesActivation of the trauma call when indicated according to predetermined guidelines UndercallUndercall A call was indicated according to the guidelines but not activatedA call was indicated according to the guidelines but not activated

6. Materials and Methods Primary outcomePrimary outcome Mortality ： death within 28 days of injuryMortality ： death within 28 days of injury Second outcomeSecond outcome Operation within 6 hoursOperation within 6 hours Need for ICUNeed for ICU

7. Results 150593 patients attended the ED with an injury150593 patients attended the ED with an injury 674 patient meet criteria674 patient meet criteria 482 （ 72% ） were correct trauma calls482 （ 72% ） were correct trauma calls 192 （ 28% ） were undercalls192 （ 28% ） were undercalls

8. Correct calls and undercalls

9. Results Uni-variate analysis revealed that the following factors were associated with undercallUni-variate analysis revealed that the following factors were associated with undercall Aged>65 years oldAged>65 years old FemaleFemale Injury results from fallsInjury results from falls Pre-injury comorbidityPre-injury comorbidity

10. Trauma call criteria

11. Undercall factor

12. Probability of Survival Undercall group was generally higher than the correct groupUndercall group was generally higher than the correct group Undercall group was less requirements for urgent operation and ICU careUndercall group was less requirements for urgent operation and ICU care Odds ratio for death was 7.1 in the undercall group for those patients with a moderate to low probability of survival （ Ps=0.5~7.5 ）Odds ratio for death was 7.1 in the undercall group for those patients with a moderate to low probability of survival （ Ps=0.5~7.5 ）

13. Probability of Survival

15. Discussion 28% patients are undercall28% patients are undercall Trauma calls were not activated in a significant proportion of patients of aged>65years old, with falls, respiratory compromise, moderate degrees of hypovolaemic shock and GCS between 9 and 13Trauma calls were not activated in a significant proportion of patients of aged>65years old, with falls, respiratory compromise, moderate degrees of hypovolaemic shock and GCS between 9 and 13

16. Why under call was happen ？ Trauma team leader use their judgement in interpreting applicationTrauma team leader use their judgement in interpreting application Elderly female suffered from low energy falls and difficult to differentiate external blunt head injury from acute strokeElderly female suffered from low energy falls and difficult to differentiate external blunt head injury from acute stroke Some of trauma call criteria are non- specific and qualitativeSome of trauma call criteria are non- specific and qualitative

17. Why under call was happen ？ Many of the criteria may only be met for a short periodMany of the criteria may only be met for a short period Some of the anatomical criteria are ambiguousSome of the anatomical criteria are ambiguous A trauma call would not be result in any significant change in managementA trauma call would not be result in any significant change in management

18. Discussion Undercall made little difference with a very lower probability of survival （ Ps=0~0.5 ） who were likely to die no matter the interventionUndercall made little difference with a very lower probability of survival （ Ps=0~0.5 ） who were likely to die no matter the intervention Undercall made no difference to patients with a high probability of survival （ Ps=0.75~1 ） who were likely to live no matter the interventionUndercall made no difference to patients with a high probability of survival （ Ps=0.75~1 ） who were likely to live no matter the intervention

19. Discussion In the group with moderate probability of survival （ Ps=0.5~0.75 ） show odds ratio for mortality in the undercall verus the correct call was 7.6In the group with moderate probability of survival （ Ps=0.5~0.75 ） show odds ratio for mortality in the undercall verus the correct call was 7.6 Undercall increased the probability of death over seven foldsUndercall increased the probability of death over seven folds