Emergency room activation due to trauma mechanism

Abstract

The quality of trauma care in Germany has been significantly increased due to the establishment of standards in the white paper on severe injury care and the S3 guidelines. A key issue of multiple trauma treatment is the trauma resuscitation unit (TRU)/emergency room management, which is associated with extensive material and human resources. From the very beginning of the introduction of structured care for the severely injured, the choice of the target hospital and the indications for TRU have been the focus of scientific research. Furthermore, a reduction of the TRU team for presumably less seriously injured patients is discussed. The emergency room assignments of alevelI trauma center (n = 686) were analyzed in more detail. Of the patients 235 were assigned with the TRU indications according to the cause of the accident (GoRB criteria) and compared with the collective of TRU patients admitted according to the severity of injuries or life-threatening signs, the so-called GoRA criteria (n = 104) during the corresponding period. In addition to basic data (age, sex), the injured region and severity (injury severity score, ISS), the length of stay in the intensive care unit (ICU) and hospital as well as the necessity for surgery and transfusion were compared. Of the emergency room allocations at the trauma center 34% were due to the cause of the accident and the severity of the injuries in this patient group was almost half as high as that of the control group with an ISS of 11. Of the patients 74% were admitted to the IMC/ICU and stayed there for an average of almost 3days. There were between 4% and 18% severe injuries (abbreviated injury scale, AIS3) and 17.9% were characterized as polytrauma with an ISS ≥ 16 points. A significant number of patients admitted to a TCU due to the cause of accident (the so-called B criteria of the white book), have severe and potentially life-threatening injuries, which necessitate a prioritized and immediate treatment by a TCU team. Whether areduced TCU team is sufficient in this situation needs to be critically examined.