Optimizing Trauma Team Activation: A Mixed-Method Analysis of De-escalation, Re-consultation, and Clinician Decision-Making at a Level I Trauma Center

Background Trauma team activation (TTA) optimizes trauma care but is resource-intensive. Secondary triage in-hospital with trauma team release (rTTA) improves resource allocation but may result in under-triage and adverse outcomes. This study aimed to assess the impact of rTTA on clinical outcomes, identify predictors of rTTA and re-consultations, and understand decision-making perspectives of trauma surgeons (TS) and emergency physicians (EPs). Methods Retrospective analysis of TTA patients from 2023 to 2024, categorizing patients as TTA without release, rTTA without re-consultation, or Rcon (rTTA requiring subsequent re-consultation). Univariate and multivariate analyses evaluated differences in clinical characteristics and predictors of Rcon. A survey on TS and EPs was administered, and responses were analyzed via descriptive statistics and thematic analysis where applicable. Results Among 2091 TTA cases, 617 (29.5%) were released, with 132 patients (21.4%) requiring re-consultation. Re-consultation was most triggered by new imaging findings. Only 3 (2.3%) Rcon patients required hemorrhage control interventions. Mortality was lower among Rcon patients (3.8%) vs rTTA without re-consultation (4.5%) and TTA without release patients (10.9%). Traffic collisions, psychiatric history, and age ≥70 years were independent predictors for re-consultation (ORs = 7.05, 3.77, and 1.89, respectively). Both TS and EPs identified the same leading factors influencing rTTA, but selection frequencies differed. Qualitative thematic analysis identified key themes driving rTTA decisions, including ED evaluation findings, prehospital-emergency department discordance, and limitations of TTA criteria in special populations. Discussion Rcon occurred in one-fifth of rTTA patients, but the low mortality suggests this secondary triage may be safe in selected patients, although variability in decision-making warrants further evaluation.