Rethinking the definition of major trauma: The need for trauma intervention outperforms Injury Severity Score and Revised Trauma Score in 38 adult and pediatric trauma centers

被引：47

作者：

Roden-Foreman, Jacob Watkin ^{[1
]}

Rapier, Nakia R. ^{[1
]}

Foreman, Michael L. ^{[1
]}

Zagel, Alicia L. ^{[2
]}

Sexton, Kevin W. ^{[3
]}

Beck, William C. ^{[3
]}

McGraw, Constance ^{[4
]}

Coniglio, Raymond A. ^{[4
]}

Blackmore, Abigail R. ^{[5
]}

Holzmacher, Jeremy ^{[6
]}

Sarani, Babak ^{[6
]}

Hess, Joseph C. ^{[7
]}

Greenwell, Cynthia ^{[8
]}

Adams, Charles A. ^{[9
,10
]}

Lueckel, Stephanie N. ^{[9
,10
]}

Weaver, Melinda ^{[11
]}

Agrawal, Vaidehi ^{[12
]}

Amos, Joseph D. ^{[13
]}

Workman, Cheryl F. ^{[14
]}

Milia, David J. ^{[15
]}

Bertelson, Annette ^{[16
]}

Dorlac, Warren ^{[17
]}

Warne, Maria J. ^{[17
]}

Cull, John ^{[18
]}

Lyell, Cassie A. ^{[19
]}

Regner, Justin L. ^{[20
]}

McGonigal, Michael D. ^{[21
]}

Flohr, Stephanie D. ^{[22
]}

Steen, Sara ^{[23
]}

Nance, Michael L. ^{[24
]}

Campbell, Marie ^{[24
]}

Putty, Bradley ^{[25
]}

Sherar, Danielle ^{[25
]}

Schroeppel, Thomas J. ^{[26
,27
]}

机构：

[1] Baylor Univ, Med Ctr, Div Trauma Crit Care & Acute Care Surg, Dallas, TX USA

[2] Childrens Minnesota, Childrens Minnesota Res Inst, Minneapolis, MN USA

[3] Univ Arkansas Med Sci, Div Acute Care Surg, Little Rock, AR 72205 USA

[4] Centura Hlth Trauma Syst, Colorado Springs, CO USA

[5] St Anthony Hosp, Lakewood, CO USA

[6] George Washington Univ, Ctr Trauma & Crit Care, Washington, DC USA

[7] Penn State Hershey Childrens Hosp, Hershey, PA USA

[8] Childrens Hosp Dallas, Trauma Dept, Dallas, TX USA

[9] Rhode Isl Hosp, Providence, RI USA

[10] Brown Univ, Warren Alpert Med Sch, Providence, RI 02912 USA

[11] Cook Childrens Med Ctr, Div Trauma, Ft Worth, TX USA

[12] Methodist Hlth Syst, Texas Clin Res Inst, Dallas, TX USA

[13] Methodist Dallas Med Ctr, Associates Surg Acute Care, Dallas, TX USA

[14] Univ North Carolina HealthCare, Chapel Hill, NC USA

[15] Med Coll Wisconsin, Div Trauma & Acute Care Surg, Milwaukee, WI 53226 USA

[16] Froedtert Mem Lutheran Hosp, Milwaukee, WI USA

[17] Univ Colorado, Hlth Med Ctr Rockies, Loveland, CO USA

[18] Greenville Hlth Syst, Dept Surg, Greenville, SC USA

[19] John Peter Smith Hlth Network, Trauma & Acute Care Serv, Ft Worth, TX USA

[20] Baylor Scott & White Med Ctr, Div Trauma & Acute Care Surg, Temple, TX USA

[21] Reg Hosp, St Paul, MN USA

[22] Helen Devos Childrens Hosp, Pediat Trauma, Grand Rapids, MI USA

[23] Aspirus Wausau Hosp, Wausau, WI USA

[24] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[25] Baylor Scott& WhiteMed Ctr Grapevine, Div Trauma, Grapevine, TX USA

[26] Univ Colorado, Sch Med, Dept Surg, Aurora, CO USA

[27] Univ Colorado, Hlth Mem Hosp, Div Trauma, Aurora, CO USA

来源：

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY | 2019年 / 87卷 / 03期

关键词：

Major trauma; trauma burden; trauma severity indices; multicenter; MORTALITY PREDICTIONS; TRISS; TRIPLETS; ISS;

D O I：

10.1097/TA.0000000000002402

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND Patients' trauma burdens are a combination of anatomic damage, physiologic derangement, and the resultant depletion of reserve. Typically, Injury Severity Score (ISS) >15 defines major anatomic injury and Revised Trauma Score (RTS) <7.84 defines major physiologic derangement, but there is no standard definition for reserve. The Need For Trauma Intervention (NFTI) identifies severely depleted reserves (NFTI+) with emergent interventions and/or early mortality. We hypothesized NFTI would have stronger associations with outcomes and better model fit than ISS and RTS. METHODS Thirty-eight adult and pediatric U.S. trauma centers submitted data for 88,488 encounters. Mixed models tested ISS greater than 15, RTS less than 7.84, and NFTI's associations with complications, survivors' discharge to continuing care, and survivors' length of stay (LOS). RESULTS The NFTI had stronger associations with complications and LOS than ISS and RTS (odds ratios [99.5% confidence interval]: NFTI = 9.44 [8.46-10.53]; ISS = 5.94 [5.36-6.60], RTS = 4.79 [4.29-5.34]; LOS incidence rate ratios (99.5% confidence interval): NFTI = 3.15 [3.08-3.22], ISS = 2.87 [2.80-2.94], RTS = 2.37 [2.30-2.45]). NFTI was more strongly associated with continuing care discharge but not significantly more than ISS (relative risk [99.5% confidence interval]: NFTI = 2.59 [2.52-2.66], ISS = 2.51 [2.44-2.59], RTS = 2.37 [2.28-2.46]). Cross-validation revealed that in all cases NFTI's model provided a much better fit than ISS greater than 15 or RTS less than 7.84. CONCLUSION In this multicenter study, NFTI had better model fit and stronger associations with the outcomes than ISS and RTS. By determining depletion of reserve via resource consumption, NFTI+ may be a better definition of major trauma than the standard definitions of ISS greater than 15 and RTS less than 7.84. Using NFTI may improve retrospective triage monitoring and statistical risk adjustments.

引用

页码：658 / 665

页数：8

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