273804 Developing and Testing a New Trauma Team Activation Protocol for Use at a Level I Pediatric Trauma Center

Monday, October 29, 2012

Rosemary Nabaweesi, MBChB, MPH , Genreal Pediatric Surgery, Johns Hopkins Blooberg Children's Center, Baltimore, MD
Paul Colombani, MD, FACS , School of Medicine/ Department of Surgery, Johns Hopkins Hospital Bloomberg Children's Center Suite 7323, Baltimore, MD
Susan Ziegfeld, CRNP , Department of General Pediatric Surgery, Johns Hopkins Hospital Bloomberg Children's Center Suite 7326, Baltimore, MD
Stephen Bowman, PhD, MHA , Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Laura Morlock, PhD , Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD
Background: Annually, trauma is the leading cause of death in children aged 1-15 years, accounting for 37% of all deaths in the US. Trauma Centers use Trauma Team Activation (TTA) protocols to triage the patients that arrive at their institutions.

Methodology: Study analyzed the performance of the TTA protocol and developed and tested the sensitivity and specificity of a new TTA protocol as it relates to intensity of resource utilization. A secondary data analysis conducted with data from 2008 to 2011 on pediatric trauam patients under 15 years. Logistic regression and Receiver Operating Characteristic curves were the analytic methods used.

Results: Out of 3,213 children, 1,991 were eligible and analyzed. The medians for age, length of stay and Injury Severity Score (ISS) were 8 years, 1 day and 4 respectively. The odds of initiating a full TTA among children with a Glasgow Coma Scale (GCS) less than 9, abnormal pulse and chest injury obtained at the scene of injury were higher than those of children who did not meet these criteria. The C-statistic for the Receiver Operating Characteristic (ROC) curve of the logistic regression for Intensity of Resource Use (IRU) was 0.7928 and 0.7964 for the logistic regression on level of TTA assignment.

Conclusion: The full TTA criteria show a stronger association with Intensity of Resource Use as compared to the level of TTA assignment. This dissertation work developed a TTA protocol that has the potential to assign patients to a TTA level in a more effective manner.

Learning Areas:
Biostatistics, economics
Public health or related organizational policy, standards, or other guidelines
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
To design a new Trauma Team Activation Protocol using Intensity of Resource Use as it relates to utilization of the Pediatric Intensive Care Unit, the Operating Room or any patients who died during this hospitalization. To compare the discriminatory ability of the new Trauma Team Activation Protocol to the existing one.

Keywords: Injuries, Methodology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the Senior Project Analyst conducting research in the department of General Pediatric Surgery for the past 3 years. I have been the administrator for 4 community grants focusing on injury prevention for our patient population. I have collaborated on both national and institutional research studies related to pediatric trauma in the past 8 years of my career. In addition, I graduate this summer in the Health Care Leadership & Management program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3081.0: Committee on Affiliates Member Poster Session