Avoiding Cribari gridlock: The standardized triage assessment tool improves the accuracy of the Cribari matrix method in identifying potential overtriage and undertriage

被引:22
作者
Roden-Foreman, Jacob W. [1 ]
Rapier, Nakia R. [1 ]
Yelverton, Luanna [1 ]
Foreman, Michael L. [1 ]
机构
[1] Baylor Univ, Med Ctr, Dallas, TX 75246 USA
关键词
Overtriage; undertriage; triage monitoring; outcomes; resource consumption; INJURY SEVERITY SCORE; MORTALITY PREDICTIONS; TRAUMA; TRISS; TRIPLETS; CARE; ISS;
D O I
10.1097/TA.0000000000001814
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND The Cribari matrix method (CMM) is the standard to identify potential overtriage and undertriage but requires case reviews to correct for the fact that Injury Severity Score does not account for physiology or comorbidities, nor is it well correlated with resource consumption. Further, the secondary reviews introduce undesirable subjectivity. This study assessed if the Standardized Triage Assessment Tool (STAT)a combination of the CMM and the Need For Trauma Interventioncould more accurately determine overtriage and undertriage than the CMM alone. METHODS The registry of an American College of Surgeons verified Level I adult trauma center in Texas was queried for all new emergency department traumas 2013 to 2016 (n = 11,110). Binary logistic regressions were used to test the associations between the triage determinations of each metric against indicators of injury severity (risk factors, complications, and mortality) and resource consumption (number of procedures in 3 days and total length of stay). RESULTS Both metrics were associated with the indicators of injury severity and resource consumption in the expected directions, but STAT had stronger or equivalent associations with all variables tested. Using the CMM, there was 50.4% overtriage and 9.1% undertriage. Using STAT, overtriage was reduced to 30.8% (relative reduction = 38.9%) and undertriage was reduced to 3.3% (relative reduction = 63.7%). CONCLUSION Using the CMM with secondary case reviews makes valid multi-institutional triage rate comparisons impossible because of the subjective and unstandardized nature of these reviews. STAT's out-of-box triage determinations (i.e., without manual case review) outperformed CMM in almost every tested variable for both over- and undertriage. STAT, an automatic, standardized method offers significant improvements compared to the current subjective system. Further, by accounting for both anatomic injury severity and resource consumption, STAT may allow trauma centers to better allocate resources and predict patient needs with fewer cases requiring manual review. LEVEL OF EVIDENCE Prognostic, level III.
引用
收藏
页码:718 / 726
页数:9
相关论文
共 21 条
[1]   Different AIS triplets: Different mortality predictions in identical ISS and NISS [J].
Aharonson-Daniel, Limor ;
Giveon, Adi ;
Stein, Michael ;
Peleg, Kobi .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2006, 61 (03) :711-717
[2]  
American College of Surgeons Committee on Trauma, NTDS DAT DICT NAT TR
[3]  
[Anonymous], 2017, R LANG ENV STAT COMP
[4]   INJURY SEVERITY SCORE - METHOD FOR DESCRIBING PATIENTS WITH MULTIPLE INJURIES AND EVALUATING EMERGENCY CARE [J].
BAKER, SP ;
ONEILL, B ;
HADDON, W ;
LONG, WB .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1974, 14 (03) :187-196
[5]   THE LACK OF FULL CORRELATION BETWEEN THE INJURY SEVERITY SCORE AND THE RESOURCE NEEDS OF INJURED PATIENTS [J].
BAXT, WG ;
UPENIEKS, V .
ANNALS OF EMERGENCY MEDICINE, 1990, 19 (12) :1396-1400
[6]   EVALUATING TRAUMA CARE - THE TRISS METHOD [J].
BOYD, CR ;
TOLSON, MA ;
COPES, WS .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1987, 27 (04) :370-378
[7]   Improved predictions from a severity characterization of trauma (ASCOT) over trauma and injury severity score [TRISS]: Results of an independent evaluation [J].
Champion, HR ;
Copes, WS ;
Sacco, WJ ;
Frey, CF ;
Holcroft, JW ;
Hoyt, DB ;
Weigelt, JA .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1996, 40 (01) :42-48
[8]   STATISTICAL-METHODS FOR COMPARING REGRESSION-COEFFICIENTS BETWEEN MODELS [J].
CLOGG, CC ;
PETKOVA, E ;
HARITOU, A .
AMERICAN JOURNAL OF SOCIOLOGY, 1995, 100 (05) :1261-1293
[9]  
Cohen J, 2003, APPL MULTIPLE REGRES, V736
[10]   THE INJURY SEVERITY SCORE REVISITED [J].
COPES, WS ;
CHAMPION, HR ;
SACCO, WJ ;
LAWNICK, MM ;
KEAST, SL ;
BAIN, LW .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1988, 28 (01) :69-77