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
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.
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.
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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