Does mortality after trauma team activation peak at shift change?. Issue 2 (April 2023)

• Record Type: Journal Article
• Authors: Schellenberg, Morgan; Owattanapanich, Natthida; Karavites, Lindsey; Wong, Monica D.; Benjamin, Elizabeth R.; Inaba, Kenji
• Is Part Of: Surgeon. Volume 21:Issue 2(2023)
• Page Start: 135
• Page End: 139
• Publication Date: 2023-04
• Subjects: Mortality -- Trauma team activation -- Shift change -- Provider response times -- Time to intervention; Surgery -- Periodicals; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617
• DOI: 10.1016/j.surge.2022.04.005
• Languages: English
• ISSNs: 1479-666X

Abstract

Abstract: Background: Prior institutional data have demonstrated trauma mortality to be highest between 06:00–07:59 at our center, which is also when providers change shifts (07:00–07:30). The objective was definition of patient, provider, and systems variables associated with trauma mortality at shift change among patients arriving as trauma team activations (TTA). Methods: All TTA patients at our ACS-verified Level I trauma center were included (01/2008–07/2019), excluding those with undocumented arrival time. Study groups were defined by arrival time: shift change (SC) (06:00–07:59) vs. non-shift change (NSC) (all other times). Univariable/multivariable analyses compared key variables. Propensity score analysis compared outcomes after matching. Results: After exclusions, 6020 patients remained: 229 (4%) SC and 5791 (96%) NSC. SC mortality was 25% vs. 16% during NSC (p < 0.001). More SC patients arrived with SBP <90 (19% vs. 11%, p < 0.001) or GCS <9 (35% vs. 24%, p < 0.001). ISS was higher during SC (43[32–50] vs. 34[27–50], p < 0.001). Time to CT scan (36[23–66] vs. 38[23–61] minutes, p = 0.638) and emergent surgery (94[35–141] vs. 63[34–107] minutes, p = 0.071) were comparable. Older age (p < 0.001), SBP <90 (p < 0.001), GCS <9 (p < 0.001), need for emergent operative intervention (p = 0.044), and higher ISS (p < 0.001) were independently associated with mortality. After propensity score matching, mortality was no different between SC and NSC (p = 0.764). Conclusions: Early morning is a low-volume, high-mortality time for TTAs. Increased mortality at shift change was independently associated with patient/injury factors but not provider/systems factors. Ensuring ample clinical resource allocation during this high acuity time may be prudent to streamline patient care at shift change. Highlights: Mortality after trauma team activation peaks at morning shift change at our center. This raises concerns that patient care may be impacted during provider handoffs. The study found that increased mortality was related to patient/injury factors only. Ample clinical resource allocation during this high acuity time should be ensured.