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Combining Cribari matrix and Need For Trauma Intervention (NFTI) to accurately assess undertriage in pediatric trauma
Niti Shahi1, Ryan Phillips2, Christen Rodenburg3
1Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, C-305, Aurora, CO 80045; Department of Pediatric Surgery, Children's Hospital Colorado, 13123 E. 16(th) Ave., Aurora, CO 80045; Department of Surgery, Department of Surgery, University of Massachusetts School of Medicine, 55 Lake Avenue North, Worcester, MA 01655.
Insights
Combining the Cribari Matrix (CM) and Need For Trauma Intervention (NFTI) tools accurately identifies pediatric trauma undertriage. This combined approach reveals undertriaged children face worse outcomes, including higher mortality and costs.
Area of Science:
- Trauma Surgery
- Pediatric Emergency Medicine
- Health Services Research
Background:
- The American College of Surgeons (ACS) Committee on Trauma aims for undertriage (UT) rates below 5% to improve survival.
- The traditional Cribari Matrix (CM) may overestimate UT, while the Need For Trauma Intervention (NFTI) tool offers a more accurate assessment in adults.
Purpose of the Study:
- To evaluate the efficacy of combining the CM and NFTI tools in accurately identifying undertriage in pediatric trauma patients.
- To compare the UT identification capabilities of CM alone versus the combined CM and NFTI approach.
Main Methods:
- A retrospective review of undertriage rates using both CM and NFTI criteria was conducted.
- Univariate analysis compared outcomes such as surgical management, transfusion needs, ventilator days, and length of stay (LOS) between CM, NFTI, and combined CM/NFTI groups.
Main Results:
- Undertriage rates were 8.2% with CM and 4.6% with NFTI. The combined CM and NFTI approach yielded a UT rate of 2.7%.
- Pediatric patients identified as undertriaged by the combined CM and NFTI criteria experienced significantly longer ICU and hospital LOS, higher mortality rates, and increased hospitalization costs.
Conclusions:
- The combination of CM and NFTI provides a more accurate identification of undertriage in pediatric trauma patients compared to either tool used alone.
- Undertriaged children face increased mortality, morbidity, and healthcare costs, highlighting the need for refined trauma activation criteria.
Background/Purpose:
The American College of Surgeons (ACS) Committee on Trauma targets undertriage (UT) rates of <5% to optimize the chances of survival. The Cribari Matrix (CM) has traditionally been employed to identify undertriage, but it likely overestimates actual undertriage. An innovative tool called "Need For Trauma Intervention" (NFTI), demonstrates a more accurate assessment of undertriage in adults. We hypothesized that using the combination of CM and NFTI would more accurately identify UT in pediatric trauma patients, compared to CM alone.
Methods:
We reviewed undertriage rates using CM and NFTI criteria. Univariate analysis was used to compare the need for surgical management, transfusion requirements, ventilator days, ICU length of stay (LOS), hospital LOS, and hospital costs between CM, NFTI, and the combination of CM and NFTI.
Results:
Undertriage rates were 8.2% with CM and 4.6% with NFTI. When CM and NFTI were combined, the UT rate was 2.7%. Pediatric patients categorized as UT by the combination of CM and NFTI had significantly longer ICU Length of Stay (LOS) (p < 0.001), hospital LOS (p < 0.001), higher mortality rates (p = 0.004), and higher hospitalization costs (p < 0.001).
Conclusions:
The combination of CM and NFTI identified UT in children, more accurately than CM or NFTI alone. Injured children who are undertriaged had higher mortality, morbidity, and cost of care. The use of CM in combination with NFTI to evaluate undertriage rates led to the identification of risk factors that may modify the activation criteria for highest and modified level trauma team activations.
Level Of Evidence:
III STUDY TYPE: Retrospective study without negative criteria (Therapeutic/Care Management).
