Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, C-305, Aurora, CO 80045; Department of Pediatric Surgery, Children's Hospital Colorado, 13123 E. 16(th) Ave., Aurora, CO 80045; Department of Surgery, Department of Surgery, University of Massachusetts School of Medicine, 55 Lake Avenue North, Worcester, MA 01655.
Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, C-305, Aurora, CO 80045; Department of Pediatric Surgery, Children's Hospital Colorado, 13123 E. 16(th) Ave., Aurora, CO 80045.
J Pediatr Surg. 2021 Aug;56(8):1401-1404. doi: 10.1016/j.jpedsurg.2020.08.013. Epub 2020 Aug 22.
BACKGROUND/PURPOSE: The American College of Surgeons (ACS) Committee on Trauma targets undertriage (UT) rates of <5% to optimize the chances of survival. The Cribari Matrix (CM) has traditionally been employed to identify undertriage, but it likely overestimates actual undertriage. An innovative tool called "Need For Trauma Intervention" (NFTI), demonstrates a more accurate assessment of undertriage in adults. We hypothesized that using the combination of CM and NFTI would more accurately identify UT in pediatric trauma patients, compared to CM alone.
We reviewed undertriage rates using CM and NFTI criteria. Univariate analysis was used to compare the need for surgical management, transfusion requirements, ventilator days, ICU length of stay (LOS), hospital LOS, and hospital costs between CM, NFTI, and the combination of CM and NFTI.
Undertriage rates were 8.2% with CM and 4.6% with NFTI. When CM and NFTI were combined, the UT rate was 2.7%. Pediatric patients categorized as UT by the combination of CM and NFTI had significantly longer ICU Length of Stay (LOS) (p < 0.001), hospital LOS (p < 0.001), higher mortality rates (p = 0.004), and higher hospitalization costs (p < 0.001).
The combination of CM and NFTI identified UT in children, more accurately than CM or NFTI alone. Injured children who are undertriaged had higher mortality, morbidity, and cost of care. The use of CM in combination with NFTI to evaluate undertriage rates led to the identification of risk factors that may modify the activation criteria for highest and modified level trauma team activations.
III STUDY TYPE: Retrospective study without negative criteria (Therapeutic/Care Management).
背景/目的：美国外科医师学会（ACS）创伤委员会将分诊不足（UT）率目标设定为<5%，以优化生存机会。传统上使用 Cribari 矩阵（CM）来识别分诊不足，但它可能高估了实际分诊不足的情况。一种名为“创伤干预需求”（NFTI）的创新工具，在成人中对分诊不足的评估更为准确。我们假设，与单独使用 CM 相比，使用 CM 和 NFTI 的组合可以更准确地识别儿科创伤患者的 UT。
我们使用 CM 和 NFTI 标准审查分诊不足率。使用单变量分析比较 CM、NFTI 和 CM 和 NFTI 组合在手术管理需求、输血需求、呼吸机使用天数、ICU 住院时间（LOS）、住院 LOS 和住院费用方面的差异。
CM 的分诊不足率为 8.2%，NFTI 为 4.6%。当 CM 和 NFTI 结合使用时，UT 率为 2.7%。CM 和 NFTI 联合分类为 UT 的儿科患者 ICU 住院时间（LOS）（p<0.001）、住院 LOS（p<0.001）、死亡率（p=0.004）和住院费用（p<0.001）显著更长。
CM 和 NFTI 的组合比 CM 或 NFTI 单独更能准确识别儿童的 UT。分诊不足的受伤儿童死亡率、发病率和医疗费用更高。使用 CM 结合 NFTI 评估分诊不足率可以识别可能改变最高和改良级别创伤团队激活标准的风险因素。
III 研究类型：无负面标准的回顾性研究（治疗/护理管理）。
