C. J. Tignanelli1,2, N. J. Davis2, A. Koestner3, L. M. Napolitano4, M. R. Hemmila4 1University Of Minnesota,Surgery,Minneapolis, MN, USA 2North Memorial Health Hospital,Surgery,Robbinsdale, MN, USA 3Spectrum Health Medical Group,Surgery,Grand Rapids, MI, USA 4University Of Michigan,Surgery,Ann Arbor, MI, USA
Introduction: A tiered trauma team activation (TTA) system aims to generate a provider response and allocation of resources proportional to the patient’s need based upon injury burden. The quality metric used to evaluate appropriateness of TTA criteria is the trauma triage matrix (TTM), typically with a cut-off of an injury severity score (ISS) of >15 used to identify a major trauma patient. The selection of an ISS>15 has been acknowledged as arbitrary and may not represent the optimal gauge of a patient’s need for TTA. Two additional methods have been proposed, the need for trauma intervention (NFTI) and the secondary triage assessment tool (STAT). In this study, we compare the effectiveness of the need for an emergent intervention within 6 hours (NEI-6) with these existing definitions for major trauma on activation appropriateness and trauma mortality.
Methods: Data from a state-wide collaborative quality initiative for trauma was utilized. The dataset contains information from 29 level 1 and 2 trauma centers from 2011–2017. Inclusion criteria were: adult patients (≥16 years) and ISS ≥5. Patients directly admitted, missing data, or with no signs of life were excluded. NEI-6 was defined as: receiving ≥5 units of packed red blood cells within the first 4 hours, any operation, angiography, chest tube, or central line placement within 6 hours of arrival, emergent intubation, or placement of an intracranial pressure monitor. Early mortality was defined as any death occurring within 48 hours of ED arrival.
Results: 73,818 patients were included in the study. 30% of trauma patients met criteria for STAT, 21% for NFTI, 20% for TTM, and 13% for NEI-6. NEI-6 was associated with the lowest rate of undertriage at 6.5% (STAT 22.3%, NFTI 14.0%, TTM 14.3%). NEI-6 best predicted undertriage mortality, early mortality, in-hospital mortality, and late (> 60 hour) mortality compared with the other methods (Table 1). Most patients who met criteria for TTM (58%), NFTI (51%), and STAT (62%) did not require emergent intervention. All four methods had similar rates of early mortality for patients who did not meet criteria (0.3% – 0.5%).
Conclusion: NEI-6 better predicted undertriage, early, and late mortality, and need for resource utilization than TTM, NFTI, and STAT. Additionally, TTM, NFTI, and STAT resulted in significantly more full TTA’s than NEI-6 without the added benefit of identifying additional patients at risk for early mortality. NEI-6 represents a novel and effective tool for determine trauma triage and activation appropriateness. This method should be considered in future iterations of the TTM.
