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Scholarly Commons > HCA Healthcare Journal > Vol. 7 > Iss. 5 (2026)

 

Keywords

trauma, wounds and injuries; triage; mortality; emergency department; trauma team; discharge disposition; nursing

Disciplines

Other Nursing | Trauma

Abstract

Background

There is a dearth of literature examining the clinical outcomes of injured patients who experience physiological deterioration in the emergency department (ED). At our trauma center, injured patients who develop hemodynamic, respiratory, or mental status instability after arrival are retriaged and upgraded to a full trauma team activation (fTA). The purpose of this study was to compare the clinical outcomes of patients with fTA based on prehospital signs and symptoms (initial) versus upgraded fTA patients.

Methods

This was a single-center, retrospective cohort study of injured patients presenting to a tertiary trauma center between June 1, 2022, and June 30, 2024. The study facility is a state-designated level I trauma center, an American College of Surgeons (ACS)–verified level II trauma center with a catchment area of 17 800 square miles, serving a population of 3.1 million in the central, southeastern region of the United States. The primary exposure was retriage with an upgrade in patient status to fTA. Bivariate analyses with Wilcoxon rank sum, Chi-square, and Fischer’s exact tests were used, where appropriate. Binary logistic regression analyses were applied, adjusting for fTA status, Elixhauser comorbidity index (ECI), payer type, race, and sex, to determine if upgraded fTA status was independently associated with injured patient mortality, high-intensity time-sensitive (HITS) interventions, and discharge disposition.

Results

A total of 1538 fTA occurred during the study period with 66 patients (4.3%) upgraded to fTA after hospital arrival. In-hospital mortality or hospice discharge was less common among upgraded fTA patients compared to initial fTA patients (9.1% vs 19.7%; P = .032). After adjusting for ECI, payer type, race, sex, and trauma activation group, patients initially activated as fTA had 2.64 times higher odds of mortality or hospice discharge compared with patients upgraded to fTA (OR, 2.64; 95% CI, 1.10-6.30; P=.029). Within the HITS subcategories, upgraded fTA patients were more likely to receive blood transfusion (63.6% vs 40.8%; P <.001) and less likely to receive mechanical ventilation (24.2%; vs 38.5% P = .020). Upgraded fTA status was not associated with patient discharge disposition.

Conclusion

Injured patients in the ED who develop signs and symptoms consistent with severe injury benefit from retriage and nurse-driven upgrades to fTA status. A hospital safety culture empowers bedside nurses to act on patients’ physiologic changes, resulting in the rapid marshalling of health care resources for life-saving interventions.

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