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Open Access

Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients

Imad S Dandan, Gail T Tominaga, Frank Z Zhao, Kathryn B Schaffer, Fady S Nasrallah, Melanie Gawlik, Dunya Bayat, Tala H Dandan, Walter L Biffl
DOI: 10.1136/tsaco-2020-000670 Published 28 April 2021
Imad S Dandan
Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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Gail T Tominaga
Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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Frank Z Zhao
Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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Kathryn B Schaffer
Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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Fady S Nasrallah
Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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Melanie Gawlik
Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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Dunya Bayat
Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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Tala H Dandan
Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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Walter L Biffl
Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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    Figure 1

    Patient flow during pit stop (PS) implementation. ED, emergency department.

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  • Table 1

    Institutional major and minor trauma team activation and TR criteria

    Major trauma activation criteriaMinor trauma activation criteriaTrauma resource criteria
    GCS score <13Ejection from/off a vehicleEMS provider judgment
    SBP <90Vehicle roll-over with unrestrained patientAge <5 or >55 years
    Respiratory rate <10 or >29Death in the same passenger compartmentPregnancy >20 weeks
    Respiratory compromising or in need of emergent airwayAuto vs. bicyclist/pedestrian thrown, run over, or with significant >20 mph impactBleeding disorders
    Respiratory compromising or in need of emergent airwayFall >3 times the patient’s height or >15 feetAnticoagulant or antiplatelet agent use (exception: aspirin)
    Intubated patients transferred from the sceneExposure to blast or explosionSevere cardiac and/or respiratory disease
    Possible airway compromiseMotorcycle crash >20 mph: ED physician or MICN judgmentLoss of consciousness
    All penetrating injuries to the head, neck, torso or extremities proximal to the elbow/kneeAmputations proximal to wrist/ankleEnd-stage renal disease requiring dialysis
    Two or more proximal long bone fracturesSuspected pelvic fracturesExtrication time >20 min
    CombativeLimb paralysisIntrusion into occupied passenger space >12 inch frontal
    Transfer patients receiving blood to maintain vital signsCrush injury, degloved or mangled extremityIntrusion into occupied passenger space >8 inch side
    Flail chestNeurologic or vascular deficit to extremities 
    Combination of trauma with burns 
    Child abuse: known or suspected with significant injury 
    • ED, emergency department; EMS, emergency medical service; GCS, Glasgow Coma Scale; SBP, systolic blood pressure; TR, trauma resource.

  • Table 2

    Resource utilization by level of trauma activation*

    StaffMajor traumaMinor traumaTrauma resource
    Trauma surgeonXXAs needed
    ED physicianXXX
    Trauma nurseXXX
    Trauma scribeXX–
    Trauma support nurseX––
    Respiratory therapistXNotifiedNotified
    Radiology technicianXXNotified
    OR nurseX––
    PhlebotomistXXNotified
    Blood bankX––
    Activation charge$22 712$20 031$4879
    • *X denotes the presence of the staff member at the time of patient arrival.

    • ED, emergency department; OR, operating room.

  • Table 3

    Patient characteristics of TA vs. TR vs. non-TR consults after pit stop implementation

    Trauma activationsTrauma resourcesNon-TR ED consultsP value
    n994474217
    Mean age47.2±22.659.9±2664.8±21.6<0.001*
    Males (%)685 (69)259 (55)121 (56)<0.001†
    Mechanism—fall (%)265 (27)283 (60)134 (62)<0.001†
    Mechanism—MVC (%)349 (35)103 (22)21 (10)<0.001*
    Mean door to physician evaluation (min)0.5±3.08.7±16.79.9±17.9<0.001*
    Mean door to CT scan (min)25.4±11.250.0±59.995.4±71.00.0495
    Mortality (%)40 (4)7 (2)7 (3)0.0348‡
    Admitted to trauma service (%)591 (60)76 (16)213 (98)<0.001†
    Mean LOS¶ (days)7.6±9.94.7±2.94.8±5.8<0.001†
    Median LOS¶ (IQR)5 (3, 8)4 (3, 5.25)3 (2, 5)<0.001§
    • Χ2 and one-way analysis of variance (ANOVA) with Tukey tests used for comparison.

    • *Difference between all three groups (Tukey test).

    • †Difference between TA and TR and TA and non-TR consult (Tukey test).

    • ‡Difference between TA and TR (Tukey test).

    • §Difference between TA and non-TR consult and TR and non-TR consult (Tukey test).

    • ¶Calculation applies only to admitted patients.

    • ED, emergency department; LOS, length of stay; MVC, motor vehicle crash; TA, trauma activation; TR, trauma resource.

  • Table 4

    TR patient characteristics before and after pit stop implementation

    TR before pit stopTR after pit stopP value
    n318474
    Mean age52.5±25.659.9±26<0.001
    Males (%)189 (59)259 (55)0.191
    Mortality (%)3 (1)7 (1.5)0.543
    Mean LOS* (days)3.7±3.44.7±2.90.0423
    Discharged from ED (%)221 (70)346 (73)0.2846
    Mean door to physician evaluation (min)6.9±10.78.6±16.70.1084
    Mean door to CT scan (min)67.7±34.650.0±59.9<0.001
    • Bold values indicate statistical signficance.

    • *Calculation applies only to admitted patients.

    • ED, emergency department; LOS, length of stay; TR, trauma resource.

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Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients
Imad S Dandan, Gail T Tominaga, Frank Z Zhao, Kathryn B Schaffer, Fady S Nasrallah, Melanie Gawlik, Dunya Bayat, Tala H Dandan, Walter L Biffl
Trauma Surg Acute Care Open Apr 2021, 6 (1) e000670; DOI: 10.1136/tsaco-2020-000670

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Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients
Imad S Dandan, Gail T Tominaga, Frank Z Zhao, Kathryn B Schaffer, Fady S Nasrallah, Melanie Gawlik, Dunya Bayat, Tala H Dandan, Walter L Biffl
Trauma Surg Acute Care Open Apr 2021, 6 (1) e000670; DOI: 10.1136/tsaco-2020-000670
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Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients
Imad S Dandan, Gail T Tominaga, Frank Z Zhao, Kathryn B Schaffer, Fady S Nasrallah, Melanie Gawlik, Dunya Bayat, Tala H Dandan, Walter L Biffl
Trauma Surgery & Acute Care Open Apr 2021, 6 (1) e000670; DOI: 10.1136/tsaco-2020-000670
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