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 |