Use Of NFTI To Evaluate Undertriage In Pediatric Trauma Patients
Niti Shahi1, Ryan Phillips1, Christen Rodenberg1, Maxene Meier1, John Recicar1, Denis Bensard2, Steven Moulton1
1Children's Hospital Colorado, Aurora, CO;2Denver Health, Denver, CO
Background (issue): The American College of Surgeons (ACS) Committee on Trauma targets undertriage (UT) rates of < 5% to optimize the chances of survival. No existing triage protocol achieves this target in isolation. The present study compares Need For Trauma Intervention (NFTI), institutional trauma activation criteria (ITAC), and the Cribari Matrix (CM) to evaluate undertriage rates at an ACS level 1 pediatric trauma.
Methods: We reviewed undertriage rates using NFTI, ITAC, and CM criteria. Univariate analysis was used to compare transfusion requirements, ventilator days, ICU days, and hospital costs. Linear regression was used to model total costs adjusting for appropriate triage (AT), transfusion requirements, need for surgical intervention, ventilator days, ICU LOS and insurance status.
Findings: Undertriage rates were lower for NFTI (1.2%) and ITAC (0.0%) compared to CM (5.3%). Patients categorized as undertriaged by NFTI or CM had statistically higher mortality rates (NFTI: p=0.0013; CM: 0.518), increased ventilator days (NFTI: p<0.0001, CM: <0.0001), increased ICU LOS (NFTI: p<0.0001; CM: p<0.0001), and higher hospitalization costs (NFTI: UT $68,500 vs AT $17,600, p<0.0012; CM UT $13,000 vs AT: $47,400; p<0.0001). Transfusion requirement, need for surgical intervention, days on ventilator, and ICU LOS were all associated with increased total cost.
Conclusions (implications for practice): A pre-hospital triage score that achieves undertriage rates of < 5% has been elusive. Optimizing undertriage in pediatric trauma patients is imperative to improving survival, resource utilization, and total hospital costs. Combining NFTI with ITAC and CM is an initial step in the right direction for improving pediatric trauma outcomes.
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