The Double 90 Rule: A New Best Practice for a Level II Trauma Center to Improve Resuscitation, Blood Administration, and Decreasing Time to CT and Hemorrhage Control Procedures

Abstract

Introduction: We noted that our surgeons would struggle to complete all the tasks needed for a complex trauma patient in a timely fashion even with a fully assembled trauma team in our non-academic Level II trauma center. We hypothesized that we could improve the speed and efficiency of resuscitation starting in the emergency department by involving interventional radiology and a second surgeon. Methods: In 2017 we implemented the Double 90 Rule whereby trauma patients with 2 confirmed systolic blood pressures <90 mmHg had the Double 90 activation. This is a second activation whereby the interventional radiologist, the backup trauma surgeon, interventional radiology nurse and tech, and the OR charge nurse are notified and expected to respond. Both surgeons are engaged from the beginning of the resuscitation to help with decision making, procedures, and operative intervention. We performed a retrospective review of our trauma registry data comparing patients before intervention in 2016 (Pre-Dbl 90) to patient cohorts from each year starting in 2018-2020 (Dbl 90). Statistical significance at p < 0.05 with 1Kruskal-Wallis and 2Chi-Square tests. Results: We found with this process an improvement in our time to definitive hemorrhage control, time to CT, backup surgeon response time, and decreased transfusion requirements with comparable Injury Severity Score (ISS) between groups. Conclusion: We have demonstrated that the Double 90 Rule is effective in a rural Level II trauma center to expedite trauma care starting in the emergency department shortening the times to CT and hemorrhage control and decreasing transfusion requirements.