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An Evaluation Of Pediatric Trauma Triage Employing The Need For Trauma Intervention Metric In Comparison To The Cribari Method
Krista J Stephenson, *Deidre L Wyrick, Melvin S Dassinger, Lori A Gurien, Patrick C Bonasso, *Robert T Maxson
University of Arkansas For Medical Sciences, Little Rock, AR

Background (issue):
Trauma centers have activation criteria to identify patients at risk of serious injury and need for timely trauma team care. Under-triaged (UT) patients are severely injured, but don't undergo a full trauma team activation (TTA). Conversely, those over-triaged (OT) receive TTA although not needed. Assessing UT and OT is currently performed using the Cribari method. The Need for Trauma Intervention Score (NFTI) was recently developed as a superior technique. We set to evaluate NFTI in comparison to Cribari in pediatric trauma.
Methods:
We conducted a retrospective cohort study of all activated traumas at a level 1 pediatric trauma center from 01/01/2019-01/01/2020, evaluating UT and OT through NFTI and Cribari. Descriptive statistics and chi-square analysis were performed.
Findings:
6,133 children were evaluated after trauma, 346 receiving TTA by program criteria. The UT rate was significantly reduced (p<0.00001) from 9.9% with Cribari (n=571/5,787) to 4.6% employing NFTI (n=269/5,787). None (n=0/393) deemed UT by Cribari but appropriate by NFTI sustained injury requiring emergent intervention; however, 48.4% (n=46/95) without TTA deemed appropriate by Cribari but UT by NFTI required emergent trauma team care, including 2 trauma bay deaths, 9 emergent laparotomies, 6 blood product resuscitations, and 32 intubations. There wasn’t a significant difference (p=0.16) in OT between Cribari (40.5%, n=140/346) and NFTI (35.2%, n=122/346). Of those who received TTA deemed OT by Cribari but not NFTI, 78.8% (n=26/33) sustained injury requiring emergent intervention.
Conclusions (implications for practice):
The Cribari method is not as reliable an indicator of severe injury, need for emergent intervention, or appropriate TTA for pediatric trauma as NFTI.


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