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{
    "pk": 7308,
    "title": "Benefit of a Tiered-Trauma Activation System for Triaging Dead-on-Arrival Patients",
    "subtitle": null,
    "abstract": "Introduction: Although national guidelines have been published for the management of critically injured traumatic cardiopulmonary arrest (TCPA) patients, many hospital systems have not implemented in-hospital triage guidelines. The objective of this study was to determine if hospital resources could be preserved by implementation of an in-hospital tiered triage system for patients in TCPA with prolonged resuscitation who would likely be declared dead on arrival (DOA).\nMethod: We conducted a retrospective analysis of 4,618 severely injured patients, admitted to our Level I trauma center from December 2000 to December 2008 for evaluation. All of the identified patients had sustained life-threatening penetrating and blunt injuries with pre-hospital TCPA. Patients who received cardiopulmonary resuscitation (CPR) for 10 minutes were assessed for survival rate, neurologic outcome, and charge-for-activation (COA) for our hospital trauma system.\nResults: We evaluated 4,618 charts, which consisted of patients seen by the MSM trauma service from December 2001 through December 2008. We identified 140 patients with severe, life-threatening traumatic injuries,who sustained pre-hospitalTCPArequiring prolongedCPRin the field andwere brought to the emergency department (ED).Group I was comprised of 108 patients sustaining TCPA (53 blunt, 55penetrating), who died after receiving, 45 minutes of ACLS after arrival. Group II, which consisted of 32 patients (25 blunt, 7 penetrating), had resuscitative efforts in the EDlasting.45 minutes, but all ultimately died prior to discharge. Estimated hospital charge-for-activation for Group I was approximately $540,000, based on standard charges of $5000 per full-scale trauma system activation (TSA).\nConclusion: Full-scale trauma system activation for patients sustaining greater than 10 minutes of prehospital TCPA in the field is futile and economically depleting. [West J Emerg Med. 2012;13(3):225–229.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution-NonCommercial  4.0",
        "short_name": "CC BY-NC 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by-nc/4.0"
    },
    "keywords": [
        {
            "word": "Tiered-Trauma Activation, Traumatic Cardiopulmonary Arrest"
        },
        {
            "word": "Charge-for-activation"
        },
        {
            "word": "triage, dead-on-arrival"
        },
        {
            "word": "Surgery, Trauma Surgery, Emergency Medicine, Injury Control"
        }
    ],
    "section": "Trauma",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/5kx1983z",
    "frozenauthors": [
        {
            "first_name": "Omar",
            "middle_name": "K",
            "last_name": "Danner",
            "name_suffix": "",
            "institution": "Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia",
            "department": "None"
        },
        {
            "first_name": "Kenneth",
            "middle_name": "L",
            "last_name": "Wilson",
            "name_suffix": "",
            "institution": "Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia",
            "department": "None"
        },
        {
            "first_name": "Sheryl",
            "middle_name": "",
            "last_name": "Heron",
            "name_suffix": "",
            "institution": "Emory University School of Medicine, Department of Emergency Medicine, Atlanta,\nGeorgia",
            "department": "None"
        },
        {
            "first_name": "Yusuf",
            "middle_name": "",
            "last_name": "Ahmed",
            "name_suffix": "",
            "institution": "King Saud University, Department of Epidemiology, College of Pharmacy, Riyadh,\nKingdom of Saudi Arabia",
            "department": "None"
        },
        {
            "first_name": "Travelyan",
            "middle_name": "M",
            "last_name": "Walker",
            "name_suffix": "",
            "institution": "Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia",
            "department": "None"
        },
        {
            "first_name": "Debra",
            "middle_name": "",
            "last_name": "Houry",
            "name_suffix": "",
            "institution": "Emory University School of Medicine, Department of Emergency Medicine, Atlanta,\nGeorgia",
            "department": "None"
        },
        {
            "first_name": "Leon",
            "middle_name": "L",
            "last_name": "Haley, Jr.",
            "name_suffix": "",
            "institution": "Emory University School of Medicine, Department of Emergency Medicine, Atlanta,\nGeorgia",
            "department": "None"
        },
        {
            "first_name": "Leslie",
            "middle_name": "Ray",
            "last_name": "Matthews",
            "name_suffix": "",
            "institution": "Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia",
            "department": "None"
        }
    ],
    "date_submitted": "2012-01-17T20:49:30Z",
    "date_accepted": "2012-01-17T20:49:30Z",
    "date_published": "2012-08-23T07:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/7308/galley/4356/download/"
        }
    ]
}