Roden-Foreman Jacob W, Rapier Nakia R, Yelverton Luanna, Foreman Michael L
Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center, Dallas, Texas.
J Trauma Nurs. 2017 May/Jun;24(3):150-157. doi: 10.1097/JTN.0000000000000283.
Many existing metrics, such as Injury Severity Score (ISS), cannot fully describe many trauma patients because of comorbidities. This study developed and evaluated the Need For Trauma Intervention (NFTI) metric as a novel indicator of major trauma. The NFTI metric was developed from an analysis of 2,396 trauma patients at a Level I trauma center. Six commonly recorded registry variables were found to be indicative of major trauma and comprised the NFTI criteria: receiving packed red blood cells within 4 hr; discharge from the emergency department (ED) to the operating room within 90 min; discharge from the ED to interventional radiology; discharge from the ED to the intensive care unit (ICU) with an ICU length of stay (LOS) of 3 or more days; mechanical ventilation outside of procedural anesthesia within 3 days; or death within 60 hr. Patients meeting any NFTI criteria are classified as having major traumas and, therefore, needing trauma activations (NFTI+). Need For Trauma Intervention was tested in an overlapping sample of 9,737 patients. Being NFTI+ was associated with higher trauma activation levels, older age, higher ISS, worse ED vitals, longer hospital LOS, and mortality. Only 13 of 561 deaths were not NFTI+ and all were in patients with do not resuscitate (DNR) orders; using ISS greater than 15 missed 73 mortalities, 46 with DNR orders. Results suggest that NFTI provides a comprehensive view of both anatomy and physiology in a manner that self-adjusts for age, frailty, and comorbidities as long as care teams adjust their treatments. Need For Trauma Intervention appears to be a unique, simple, and effective tool to retrospectively identify major trauma, regardless of ISS.
许多现有指标，如损伤严重度评分（ISS），由于存在合并症，无法全面描述许多创伤患者的情况。本研究开发并评估了创伤干预需求（NFTI）指标，将其作为重大创伤的一种新型指标。NFTI指标是通过对一家一级创伤中心的2396例创伤患者进行分析得出的。研究发现六个常见的登记变量可指示重大创伤，并构成了NFTI标准：在4小时内接受浓缩红细胞输注；在90分钟内从急诊科（ED）转入手术室；从ED转入介入放射科；从ED转入重症监护病房（ICU）且ICU住院时长（LOS）为3天或更长时间；在3天内进行非手术麻醉下的机械通气；或在60小时内死亡。符合任何NFTI标准的患者被归类为患有重大创伤，因此需要启动创伤急救（NFTI+）。在9737例患者的重叠样本中对创伤干预需求进行了测试。NFTI+与更高的创伤急救启动水平、年龄较大、ISS较高、ED生命体征较差、住院时间较长以及死亡率相关。561例死亡患者中只有13例不是NFTI+，且所有这些患者都有“不要复苏”（DNR）医嘱；使用ISS大于15会漏诊73例死亡病例，其中46例有DNR医嘱。结果表明，只要护理团队调整治疗方案，NFTI就能以一种自我调整年龄、虚弱程度和合并症的方式，全面反映解剖学和生理学情况。创伤干预需求似乎是一种独特、简单且有效的工具，可用于回顾性识别重大创伤，而无需考虑ISS。
