Severity and resource utilisation among trauma patients undergoing trauma team activation in four Danish trauma units: a prospective cohort study

Abstract

Evidence on trauma epidemiology and outcomes largely originates from major trauma centres, while data from regional trauma units remain limited. The aim of this study was to describe the epidemiology, management, and outcomes of patients undergoing trauma team activation in the trauma units of Region Zealand, Denmark. We conducted a prospective multicentre observational study across four regional trauma units in Region Zealand, Denmark, between 1 March 2024 and 28 February 2025. All consecutive patients undergoing trauma team activation were included. Data included demographics, injury mechanisms, injury severity, in-hospital management, and mortality. Analyses were descriptive. A total of 1611 patients were included. Median age was 38 years [IQR 20–58], and 60.5% were male. The most common injury mechanisms were traffic-related injuries (53%), falls (22%), and equestrian-related accidents (13%). Median Injury Severity Score was 1 [IQR 0–5] and 94% had Injury Severity Score < 16. Secondary transfer to a major trauma centre occurred in 3.8% of cases, and 90-day mortality was 2.6%. Trauma admissions occurred predominantly outside regular daytime workflow, with a peak in the late afternoon and early evening. Median TTA duration was 58 minutes [IQR 43–76] and CT imaging was performed in 86.7% of cases. Following trauma team activation, 55.2% of patients were discharged directly and 4.6% required intensive care unit admission. Most patients undergoing trauma team activation in regional trauma units had minor injuries, were discharged directly from the emergency department, and infrequently required intensive care unit admission or secondary transfer. Despite this, trauma team activation had a median duration around one hour and showed marked diurnal variation, with a peak in the late afternoon and early evening when staffing and clinical resources are typically more limited. These findings highlight opportunities to optimise trauma team activation criteria and organisational structures to better align resource utilisation with patient acuity. Not applicable.