Evaluating Delivery of Trauma-Informed Care in the Trauma Bay.

Importance: Trauma-informed care (TIC) is an approach that promotes patient safety, dignity, and agency within the clinical environment and has recently been incorporated into Advanced Trauma Life Support recommendations. Objective: To characterize how TIC principles are applied during the initial evaluation of injured patients in the trauma bay and to assess whether TIC delivery differs between English-speaking patients and Spanish-speaking patients. Design, Setting, and Participants: This cross-sectional study analyzed audiovisual recordings from trauma assessments at 6 level I trauma centers enrolled from March 2024 to April 2025. Patients were included if they were alert, hemodynamically stable (systolic blood pressure >90; heart rate <120), and had a Glasgow Coma Scale score greater than 13. Data were analyzed from August to November 2025. Main Outcomes and Measures: A standard checklist was used to assess basic communication (eg, introductions), empathetic communication (eg, reassurances), and comprehensiveness of the examination. Differences in these elements were compared between English- and Spanish-speaking patients using χ2, t tests, and Wilcoxon rank sum analyses. Results: A total of 291 patient encounters (median [IQR] age, 41 (28-63) years; 162 male [55.7%]) were reviewed. The median (IQR) Injury Severity Score was 9 (1-14), and 216 encounters (74.6%) were for blunt injuries. There were 236 English-speaking patients (81.1%), 52 Spanish-speaking patients (17.9%), and 17 patients (32.7%) had an interpreter present for any part of the evaluation. A physician introduced themselves in 74 encounters (28.8%), less often for Spanish-speaking patients than English-speaking patients (3 of 49 encounters [6.1%] vs 71 of 208 encounters [34.1%]; P < .001). Nurse introductions occurred in 26 encounters (10.0%). Spanish-speaking patients, compared with English-speaking patients, received fewer verbal reassurances (median [IQR], 1 [0-1] vs 2 [1-4] assurances; P < .001) and were less likely to be given at least 1 physical reassurance (7 of 51 encounters [13.7%] vs 118 of 229 encounters [51.5%]; P < .001). Approximately half of patient interventions included any communication (mean [SD], 55.4% [29.5 percentage points]), with lower rates for Spanish-speaking patients than English-speaking patients (mean [SD], 46.5% [28.8 percentage points] vs 57.3% [29.4 percentage points]; P = .02). Few patients (97 [34.2%]) had complete physical examinations, and this was less frequent for Spanish-speaking patients than English-speaking patients (7 [13.7%] vs 90 [38.6%]; P < .001). Conclusions and Relevance: This cross-sectional study found that TIC practices, including fundamental communication, empathetic engagement, and patient-centered behaviors, were inconsistently delivered during acute trauma resuscitation. Spanish-speaking patients experienced lower rates of trauma-informed communication and were less likely to receive a complete examination. Improving the quality and equity of trauma care will require deliberate integration of trauma-informed principles into trauma education, performance improvement, and clinical practice.