Trauma team activation (TTA) is widely recognized to improve outcomes in trauma care; however, few studies have examined its long-term maturation and the effects of protocolized implementation. This study aimed to evaluate the impact of a comprehensive trauma team protocol introduced in 2012 in a single institution and to identify factors associated with patient outcomes.

We conducted a retrospective cohort study of trauma patients who underwent TTA between 2006 and 2023 at a single medical center in Taiwan. The generalized protocol was implemented in 2012 for trauma patients who fulfilled the TTA criteria. Patients <18 years old, who were dead or had unknown vital signs on arrival at the emergency department (ED) or had been transferred from other institutions were excluded. The primary outcomes were the patient clinical outcomes; the time intervals to critical decision-making points after TTA were evaluated as secondary outcomes. Logistic regression was performed to identify independent risk factors.

The study included 3002 patients. Compared with patients in the pre-protocolized stage ( n  = 518), patients in the protocolized stage ( n  = 2484) had a higher survival rate (90.5% vs. 79.7%, p   <  0.001), lower morbidity (0.8% vs. 10.6%, p  <  0.001), a higher success rate of nonoperative management (NOM) (39.0% vs. 27.2%, p  <  0.001), and shorter ED-to-computed tomography (CT) times (39.0 vs. 52.6 min, p  = 0.001). Multivariate analysis identified age, Trauma Score and Injury Severity Score (TRISS), Glasgow Coma Scale (GCS) score, and treatment stage as independent predictors of survival. In addition, timely ED-to-CT (≤60 min) was more frequent in the protocolized stage.

Implementing a protocolized TTA system is feasible and can enhance the quality of trauma care, both in processes and outcomes. The treatment stage itself, independent of patient condition, serves as a determinant of clinical results. Tertiary trauma centers should consider adopting a standardized TTA protocol to improve patient outcomes.