Clinical Implications of Over- and Under-Triage Using Need for Trauma Intervention and Cribari Indices.

Autor:	Lenart EK; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA., Byerly SE; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA., Gross MG; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA., Ali YM; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA., Evans CR; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA., Easterday TS; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA., Howley IW; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA., Kerwin AJ; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA., Fischer PE; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA., Filiberto DM; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2024 Sep; Vol. 90 (9), pp. 2176-2181. Date of Electronic Publication: 2024 Apr 13.
DOI:	10.1177/00031348241246181
Abstrakt:	Background: Need for Trauma Intervention (NFTI) score was proposed to help identify injured trauma patients while minimizing under (UT) and over triage (OT). Using a national database, we aimed to describe UT and OT of NFTI vs standard Cribari method (CM) and hypothesized triage sensitivity remains poor. Methods: The 2021 Trauma Quality Improvement Program (TQIP) database was queried. Demographics, mechanism, verification level, interfacility transfer (IF), and level of activation were collected. Patients were stratified by both NFTI [+ vs -] and CM [Injury severity score (ISS) < 15 vs > 15]. UT was defined as NFTI + or ISS >15 without full trauma activation. Results: 1,030,526 patients were identified in TQIP. 84,969 were UT and 97,262 were OT using NFTI while 94,020 were UT and 108,823 were OT using CM. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NFTI is 49%, 89%, 45%, and 90%, respectively vs 43%, 87%, 39%, and 89% of CM, respectively. Age was higher in the UT group using both scores (52 vs 42, P < .0001 and 54 vs 42, P < .0001, respectively). Using MLR, level 2 and 3 verification, blunt mechanism, female, IF, and older age were associated with UT in both NFTI and CM. Level 1 verification, penetrating mechanism, male, no IF, and younger age were associated with OT. Conclusions: Current prehospital triage criteria have poor sensitivity for identifying severely injured trauma patients by both NFTI and CM. UT increases as age of the patient increases. Further studies are needed to improve triage. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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