Table 2.
Process indicators (TTA Trauma Team Activation, GCS Glasgow Coma Scale, TBI traumatic brain injury, ED emergency department, AIS Abbreviated Injury Scale, ISS Injury Severity Score, CT computed tomography, TEG tromboelastography, ROTEM rotational thromboelastometry, ICU intensive care unit, EX-LAP explorative laparotomy, SBP systolic blood pressure, OR operating room, E-FAST extended focused assessment with sonography in trauma, REBOA resuscitative endovascular balloon occlusion of the aorta, CNS central nervous system)
| Category | Subcategory | Indicator | Patients |
|---|---|---|---|
| Process | Triage/prehospital | Time to first medical contact (on scene) | All patients |
| Prehospital time | ISS > 16 | ||
| Time to definitive trauma center | All patients | ||
| Acute pain management | Patients with documented pain assessment | ||
| Intubation of unconscious patients | Prehospital GCS < 9 | ||
| Pelvic binder in pelvic fracture | Mechanically and/or hemodynamically unstable pelvic fractures (AIS 3-5) | ||
| Field triage rate (undertriage) | All patients | ||
| Patient in shock with documented blood pressure who dies with no Emerg. Dept. thoracotomy or REBOA placement | Patients died in ER arrived with a documented blood pressure | ||
| Emergency dept. management | Trauma Team Activation (TTA) | Patients requiring TTA for whom TTA was activated | |
| Airway secured in ED for patients with GCS <9 | Patients with GCS < 9 | ||
| Tracheal intubation (GCS<9) | Patients with GCS < 9 | ||
| Adequate rewarming measures for hypothermia (temperature ≤ 35 °C) | Patients admitted to a trauma center | ||
| Operative management of patients with an abdominal gunshot wound | Patients with a penetrating abdominal injury by firearm | ||
| Tetanus prophylaxis | All patients with exposed soft tissues | ||
| Antibiotics for open fractures | Number of patients with an open fracture receiving an antimicrobial agent within 1 h of hospital arrival | ||
| Time to cranial CT for patients with GCS < 14 | GCS < 14 | ||
| Patient with GCS < 13 has a head CT within 4 h of arrival in ED | Adult TBI: GCS < 13; pediatric TBI: GCS < 12 | ||
| Time to CT scan from ED admission | ED patients with blunt force injuries AND trauma team activation (TTA) OR ED documented GCS < 9, receiving CT scan within 1 h of ED arrival | ||
| E-FAST in patient without CT | Patients without CT | ||
| Blood analysis performed/BE documented | All patients | ||
| Coagulation test (TEG/ROTEM) | All patients with active bleeding | ||
| ED stay > 1 h for patients with GCS < 9 or intubated (level I/II) | TBI patients with GCS ≥ 4 or ≤ 10 in a level I/II trauma center | ||
| ED stay > 1 h for patients admitted to ICU or OR | TBI patients with GCS ≥ 4 or ≤ 8 or intubated in a level I/II trauma center | ||
| Massive trasfusion protocol activation | Patients with active bleeding and signs of shock | ||
| Time to start of blood transfusion | Patients with at least one unit transfused | ||
| Orthopedic response time > 30 min in emergent case | Patients with orthopedic trauma | ||
| Unplanned ICU admission | Patients primarily admitted to ward then moved to ICU | ||
| Surgical management | Definitive bleeding control (in patients with PTM) | All patients age 18 years and older with an injury diagnosis AND prescribed a massive transfusion who receive attempted definitive bleeding control (laparotomy, thoracotomy, percutaneous therapy) within 30 min of the massive transfusion prescription | |
| Trauma | Time to first emergency surgery | Operated patients | |
| Delay to OR-EX-LAP (> 2 h): trauma | Operated patients | ||
| Time to laparotomy < 1 h for patients with a proven intra-abdominal bleeding causing hypotension | SBP < 90 or requires > 4 units of packed red blood cells in the first hour for hemorrhage due to injury | ||
| Time to surgery in patients with shock | SBP < 90 | ||
| Patients with bleeding pelvic fracture who die within 60 min from ED arrival without preperitoneal pelvic packing or REBOA placement | Patients with bleeding pelvic fracture | ||
| Neurosurgical | Time to surgical brain decompression | TBI with indication for decompression | |
| Patients with epidural or subdural hematoma receiving craniotomy > 4 h after arrival | Patients with epidural or subdural hematoma | ||
| Enteral or parenteral feeding for severe head injury patients < 7 days post-injury | TBI patients with GCS ≤ 10 | ||
| Failure monitoring of intracranial pressure in severe TBI with pathological CT finding | Severe TBI | ||
| Orthopedic | Open fracture grade 3 to OR > 8 h | Open fracture grade 3 | |
| Open long bone fracture surgery < 6 h | Open fracture of the tibia, fibula, humerus, radius, or ulna | ||
| Patient with pelvic fracture and hemodynamic instability on ED arrival with provisional stabilization of pelvic ring fracture within 12 h from arrival at the trauma center | Patients with SBP < 90 or requiring > 4 units of packed red blood cells in the first hour | ||
| Open fracture grade 1 or 2 to OR >16 h | Open fracture grade 1 or 2 | ||
| Open fractures—stabilized > 24 h | Long bones open fractures | ||
| Vascular | Ischemic limb revascularized < 6 h | Ischemic limb following vascular trauma | |
| Time to restore perfusion | Ischemic limb following vascular trauma | ||
| Deep vein thrombosis prophylaxis (within 24 h) in immobile patients | Patients immobilized ≥ 24 h (without CNS bleeds or spine/CNS surgery within 24 h) | ||
| Patients who experienced limb amputation without previous vascular shunt placement | Patients with limb amputation |