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

Abstract

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. LEVEL OF EVIDENCE Prognostic, level IV.

ANOVA-Based Analysis of Early Blood Transfusions on Hemodynamics with Severely Injured Trauma Using Bedside Ultrasound Imaging

“…In the MBT group, ΔVpeak BA (21.55 ± 1.42 vs. 14.92 ± 1.36) and ΔVpeak FA (17.53 ± 1.38 vs. 13.66 ± 1.51) were obviously higher (P < 0.05). is was aligned with the research results of Roden-Foreman et al [20]. Arteries transport blood rich in oxygen and various nutrients to various parts of the body, while severely injured trauma can cause abnormal operation of peripheral arteries.…”

Is it time for firearm injury to be a separate activation criteria in children? An assessment of penetrating pediatric trauma using need for surgeon presence

“…4 Early identification of severe injury and prehospital interventions have been previously shown to improve outcomes. 9 This may be an advantage over other systems such as the Need for Trauma Intervention (NFTI) method, 10 in which many of the criteria are not readily known until 60e72 h after arrival. The NSP system has all components identified by the time the patient leaves the trauma bay, and many times even earlier than this.…”

Mortality prediction by ‘Life Threat Index’ compared to widely used trauma scoring systems

“…TRISS results are dependent on GCS score, which are often changed between EMS and Emergency Departments, which is rather caused by dynamic changes appearing after initial trauma, while GCS showed good inter-observer agreement [27]; therefore, it should be proposed that in TRISS evaluation only one predetermined GCS score should be used, such as GCS evaluation in the Emergency Department. Additionally, RTS which also relies on GCS and other physiological parameters, is susceptible to inappropriate scoring due to changes in a patient's status, or coding differences between coders, and major trauma definitions based on newlyproposed methodology or scales are introduced [28].…”