Redefining the Trauma Triage Matrix: The Role of Emergent Interventions

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Health Services Research

Background:

• Tiered trauma team activation (TTA) systems aim to match resources with patient injury burden.
• Current TTA appropriateness metrics include the trauma triage matrix (TTM), need for trauma intervention (NFTI), and secondary triage assessment tool (STAT).

Purpose of the Study:

• To compare the effectiveness of the need for an emergent intervention within 6 hours (NEI-6) against existing TTA metrics.
• To evaluate NEI-6's performance in predicting undertriage, mortality, and resource utilization.

Main Methods:

• Retrospective study using data from the Michigan Trauma Quality Improvement Program (2011-2017).
• Included adult patients (≥16 years) with an Injury Severity Score (ISS) ≥5.
• Compared NEI-6 with TTM, NFTI, and STAT for 73,818 patients across 31 trauma centers.

Main Results:

• NEI-6 identified the lowest percentage of patients (13%) requiring activation, compared to STAT (30%), NFTI (21%), and TTM (20%).
• NEI-6 demonstrated the lowest undertriage rate (6.5%) and best predicted undertriage mortality, early, in-hospital, and late mortality.
• A significant proportion of patients meeting TTM, NFTI, and STAT criteria did not require emergent intervention (51-62%).

Conclusions:

• NEI-6 outperforms TTM, NFTI, and STAT in reducing undertriage and accurately identifying patients at risk for mortality.
• NEI-6 optimizes trauma activation by minimizing unnecessary activations while effectively identifying high-risk patients.
• NEI-6 presents a novel, more effective tool for determining trauma activation appropriateness.