The University of Tennessee College of Medicine Chattanooga (Drs Harrell and Barker); and Erlanger Health System Trauma Services, Chattanooga, Tennessee (Mss Spain, Whiteaker, and Poulson).
J Trauma Nurs. 2020 Jul/Aug;27(4):195-199. doi: 10.1097/JTN.0000000000000514.
The American College of Surgeons Committee on Trauma (ACS-CoT) sets standards for appropriate trauma activation criteria. Overtriage and undertriage rates are traditionally determined by the Cribari matrix using the Injury Severity Score (ISS). In 2016, the Need for Trauma Intervention (NFTI) criteria were developed by Baylor University Medical Center to overcome weaknesses in the Cribari matrix methodology.
A retrospective review of trauma triage rates was conducted from March 2018 to February 2019. Overtriage rates were calculated using the Cribari matrix and then further evaluated using modified NFTI (MNFTI) criteria. Overtriaged patients meeting MNFTI criteria were considered appropriately triaged and deleted from the overtriage category, and adjusted triage rates were determined. Demographic, injury, and outcome data were compared between MNFTI-positive and MNFTI-negative groups. A logistic regression analysis was performed to assess for predictors of patient mortality.
Using the Cribari matrix, 248 patients were identified as overtriaged. Of these, 133 (53.6%) were found to meet MNFTI criteria. The average monthly overtriage rate was reduced from 55% using the Cribari matrix to 26% after applying the MNFTI criteria. Within the Cribari overtriage patient group, MNFTI-positive patients had significantly longer hospital length of stay (LOS) (3.7 vs. 6.0 days, p = .016), intensive care unit LOS (1.2 vs. 4.2 days, p < .001), and ventilator days (0.6 vs. 1.6 days, p = .002) than MNFTI-negative patients. A multivariable logistic regression analysis found that meeting any of the MNFTI criteria significantly increased the odds of mortality (OR = 10.38; 95% CI [3.87, 27.84], p < .001).
Discharge ISS may not accurately reflect the patient's acuity on presentation. Applying MNFTI criteria to the Cribari matrix improved overtriage rates and may more accurately reflect need for full trauma team activation. Patients meeting MNFTI criteria had worse outcomes overall and had a 10-fold increase in the odds of mortality.
美国外科医师学会创伤委员会 (ACS-CoT) 为适当的创伤激活标准设定了标准。过度治疗和治疗不足的比率传统上是使用损伤严重程度评分 (ISS) 通过 Cribari 矩阵来确定的。2016 年，贝勒大学医学中心制定了创伤干预需求 (NFTI) 标准，以克服 Cribari 矩阵方法的弱点。
对 2018 年 3 月至 2019 年 2 月的创伤分诊率进行了回顾性研究。使用 Cribari 矩阵计算过度治疗率，然后使用改良的 NFTI (MNFTI) 标准进一步评估。符合 MNFTI 标准的过度治疗患者被认为是适当分诊的，并从过度治疗类别中删除，并确定调整后的分诊率。比较 MNFTI 阳性和 MNFTI 阴性组之间的人口统计学、损伤和结局数据。进行逻辑回归分析以评估患者死亡率的预测因素。
使用 Cribari 矩阵，确定 248 名患者为过度治疗。其中，133 名（53.6%）符合 MNFTI 标准。使用 MNFTI 标准后，平均每月过度治疗率从 Cribari 矩阵的 55%降至 26%。在 Cribari 过度治疗患者组中，MNFTI 阳性患者的住院时间 (LOS)（3.7 天 vs. 6.0 天，p =.016）、重症监护病房 LOS（1.2 天 vs. 4.2 天，p <.001）和呼吸机天数（0.6 天 vs. 1.6 天，p =.002）明显长于 MNFTI 阴性患者。多变量逻辑回归分析发现，符合任何 MNFTI 标准都会显著增加死亡率的几率（OR=10.38；95%CI[3.87,27.84]，p<.001）。
出院 ISS 可能无法准确反映患者就诊时的病情严重程度。将 MNFTI 标准应用于 Cribari 矩阵可提高过度治疗率，并可能更准确地反映全面创伤团队激活的需求。符合 MNFTI 标准的患者总体预后较差，死亡率增加 10 倍。
