This review describes the evidence exploring the use of a two-tier trauma team activation system, reviewing the background, history, data available and potential benefits and downsides. The current evidence suggests that a two-tier system may be a lean, cost-effective system, focussed on patient outcome, which could be implemented throughout the UK. Despite its current use in some hospitals, there is limited data from similar systems supporting this in a UK setting. Specific activation criteria need to be validated to ensure appropriate activation of trauma teams, ensuring optimal patient outcome and ensuring best practice.
American College of Surgeons: Committee on Trauma (1998) Resources for the optimal care of the injured patient, Chicago: American College of Surgeons.
2.
American College of Surgeons: Committee on Trauma (2006) Resources for the optimal care of the injured patient, Chicago: American College of Surgeons.
3.
AuEHKHoldgateA (2010) Characteristics and outcomes of patients discharged home from the Emergency Department following trauma team activation. Injury41(5): 465–469.
4.
Burdett-SmithPAireyMFranksA (1995) Improvements in trauma survival in Leeds. Injury26(7): 455–458.
5.
ChenLESnyderAKMinkesRK (2004) Trauma stat and trauma minor: are we making the call appropriately?Paediatric Emergency Care20(7): 421–425.
6.
ClemmesenMLRytterSBirchK (2006) Should high-energy traumas always result in a trauma team call? (in Danish). Ugeskrift for Laeger168(35): 2916–2916.
7.
CurtisKOlivierJMitchellR (2011) Evaluation of a tiered trauma call system in a level 1 trauma centre. Injury42(1): 57–62.
8.
D'AmoursSSugrueMRussellR (2002) Clinical guidelines: pre-hospital information and hand-over. Handbook of Trauma Care, 6th edn. Sydney: University of New South Wales, pp. 67–68.
9.
DavisTDinhMRoncalS (2010) Prospective evaluation of a two- tiered trauma activation protocol in an Australian major trauma referral hospital. Injury41(5): 470–474.
10.
DeKeyserFGParatoreASenecaRP (1994) Decreasing the cost of trauma care: a system of secondary inhospital triage. Annals of Emergency Medicine23(4): 841–844.
11.
DemetriadesDKaraiskakisMVelmahosG (2002) Effect on outcome of early intensive management of geriatric trauma patients. British Journal of Surgery89(10): 1319–1322.
12.
DemetriadesDSavaJAloK (2001) Old age as a criterion for trauma team activation. Journal of Trauma51(4): 754–756.
13.
DicksonEWAnguelovZVetterickD (2009) Use of lean in the Emergency Department: a case series of 4 hospitals. Annals of Emergency Medicine54(4): 504–510.
14.
EastesLSNortonRBrandD (2001) Outcomes of patients using a tiered trauma response protocol. Journal of Trauma50(5): 908–913.
15.
FieldVWestranGHorneS (2012) The changing face of major trauma: significant changes in the demographics of major trauma in the South West of England over the last 20 years. Acad Emergency Medicine19(6): 737–737.
16.
GomezMJFerraroCACharlsonDA (1991) The cost effectiveness of a two tier trauma response. Journal of Trauma and Acute Care Surgery31(12): 1716–1716.
17.
HaukoosJSByynyRLEricksonC (2011) Validation and refinement of a rule to predict emergency intervention in adult trauma patients. Annals of Emergency Medicine58(2): 164–171.
18.
HolcombJBNilesSEMillerCC (2005) Prehospital physiologic data and lifesaving interventions in trauma patients. Military Medicine170(1): 7–13.
19.
KortbeekJBAl TurkiSAAliJ (2008) Advanced trauma life support, 8th edition, the evidence for change. Journal of Trauma64(6): 1638–1650.
20.
KouzminovaNShatneyCPalmE (2009) The efficacy of a two-tiered trauma activation system at a level I trauma center. Journal of Trauma67(4): 829–833.
21.
LarsenKTUlebergOSkogvollE (2010) Differences in trauma team activation criteria among Norwegian hospitals. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine18: 21–21.
22.
LehmannRBeekleyACaseyL (2009) The impact of advanced age on trauma triage decisions and outcomes: a statewide analysis. American Journal of Surgery197(5): 571–574.
23.
LoweRJBakerRJ (1973) Organization and function of trauma care units. Journal of Trauma13(4): 285–290.
24.
NewgardCDZiveDHolmesJF (2011) A multisite assessment of the American College of Surgeons Committee on trauma field triage decision scheme for identifying seriously injured children and adults. Journal of the American College of Surgeons213(6): 709–721.
25.
National confidential enquiry into patient outcomes and death (2007) Trauma: who cares. Available at: http://www.ncepod.org.uk/2007t.htm (accessed 18 March 2013).
26.
OcakGSturmsLHoogeveenJ (2009) Prehospital identification of major trauma patients. Langenbeck’s Archives of Surgery394(2): 285–292.
27.
OchsnerMGSchmidtJARozyckiGS (1995) The evaluation of a two-tier trauma response system at a major trauma center: is it cost effective and safe?Journal of Trauma39(5): 971–971.
28.
PetrieDLanePStewartT (1996) An evaluation of patient outcomes comparing trauma team activated versus trauma team not activated using TRISS analysis: trauma and injury severity score. Journal of Trauma41(5): 870–875.
29.
PitchfordLSmithJ (2007) Differences in trauma team activation criteria used by hospitals in the South West Peninsula. Emergency Medicine Journal24(5): 372–372.
30.
PlaisierBRMeldonSWSuperDM (1998) Effectiveness of a 2-specialty, 2-tiered triage and trauma team activation protocol. Annals of Emergency Medicine32(4): 436–441.
31.
PotterDKehoeASmithJE (2013) The sensitivity of pre-hospital and in-hospital tools for the identification of major trauma patients presenting to a major trauma centre. Journal of the Royal Naval Medical Service99(1): 16–19.
32.
RainerTHCheungNKYeungJHH (2007) Do trauma teams make a difference?: a single centre registry study. Resuscitation73(3): 374–381.
33.
RogersARogersFBradburnE (2012) Old and undertriaged: a lethal combination. The American Surgeon78(6): 711–715.
34.
Royal College of Surgeons (2000) Better care for the severely injured. Report, Royal College of Surgeons, London.
35.
RehnMLossiusHMTjosevikKE (2012) Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre. British Journal of Surgery99(2): 199–199.
36.
RyanJMGaudryPLMcDougallPA (1998) Implementation of a two-tier trauma response. Injury29(9): 677–683.
37.
SasserSMHuntRCFaulM (2012) Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recommendation Report, pp. 1–20.
38.
ScheetzLJ (2010) Prehospital factors associated with severe injury in older adults. Injury41(9): 886–893.
39.
SmithJCaldwellESugrueM (2005) Difference in trauma team activation criteria between hospitals within the same region. Emergency Medicine Australasia17(5–6): 480–487.
40.
SmithDCChapitalAUperesaBMB (2011) Trauma activations and their effects on non- trauma patients. Journal of Emergency Medicine41(1): 90–94.
41.
SpaniolasKChengJDGestringML (2010) Ground level falls are associated with significant mortality in elderly patients. Journal of Trauma69(4): 821–825.
42.
TinkoffGHO'ConnorREFuldaGJ (1996) Impact of a two-tiered trauma response in the emergency department: promoting efficient resource utilization. Journal of Trauma41(4): 735–740.
43.
WilliamsDFogliaRMegisonS (2011) Trauma activation: are we making the right call? A 3-year experience at a Level I pediatric trauma center. Journal of Paediatric Surgery46(10): 1985–1991.
44.
YatesDWWoodfordMHollsS (1992) Preliminary analysis of the care of injured patients in 33 British Hospitals: first report of the United Kingdom Major Trauma Outcome Study. British Medical Journal205(6858): 737–740.
