Non-compliance with ACS-COT recommended criteria for full trauma team activation is associated with undertriage deaths

Background The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT verified trauma center compliance with these criteria is associated with low under-triage rates and improved overall mortality. Methods Data from a state-wide collaborative quality initiative was utilized. We used data collected from 2014 through 2016 at 29 ACS verified level 1 and 2 trauma centers. Inclusion criteria were: adult patients (≥16 years) and ISS ≥5. Quantitative data existed to analyze four of the ACS-6 criteria (ED SBP≤90 mmHg, respiratory compromise/intubation, central GSW, and GCS15) and did not receive a full TTA. Results 51,792 patients were included in the study. Compliance with ACS-6 minimum criteria for full TTA varied from 51% to 82%. Presence of any ACS-6 criteria was associated with a high intervention rate and significant risk of mortality (OR 16.7, 95% CI 15.2-18.3, p

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