Efficiency of activation of the trauma team in a Norwegian trauma referral centre

Objective: To evaluate the efficiency (sensitivity, specificity, positive predictive value, overtriage, and undertriage) of activation of the trauma team in a Norwegian trauma referral centre. Design: A cohort study with univariate and multivariate analysis. Setting: A primary trauma hospital and trauma referral centre Norway. Subjects: 3391 injured patients admitted during a 12 months period, starting January 15th, 1990. Main outcome measures: Activation of the trauma team for severely injured patients and factors associated with correct activation. Result: Of the 3383 injured patients admitted, 283 (8%) were classified as severely injured. Of 507 activations of the trauma team. 240 (47%) were for severely injured patients (sensitivity 85%, undertriage 15%. specificity 91%, overtriage 9%, positive predictive value 0.47). The system of activation was significantly more efficient for patients admitted by anaesthetist-manned ambulances than by ordinary ground ambulances (sensitivity 94% compared with 83%, corresponding positive predictive value 0.55 and 0.33. p < 0.05). Female sex and age over 70 years were independent factors associated with significantly less use of the trauma team in severely injured patients (p < 0.05). Conclusion: The undertriage rate of 15% and a positive predictive value of only 0.47 indicates a need for improvement of our activation system. Female sex and age over 70 years were significantly associated with undertriage in severely injured patients. Our protocol for triage and the initial treatment of severely injured patients has been revised in the light of these findings, and we have established a trauma registry.