Avoiding Cribari gridlock 2: The standardized triage assessment tool outperforms the Cribari matrix method in 38 adult and pediatric trauma centers

Roden-Foreman, Jacob W.; Rapier, Nakia R.; Foreman, Michael L.; Cribari, Chris; Parsons, Megan; Zagel, Alicia; Cull, John D.; Coniglio, Raymond A.; McGraw, Constance; Blackmore, Abigail R.; Lyell, Cassie A.; Adams, Charles A.; Lueckel, Stephanie N.; Regner, Justin L.; Holzmacher, Jeremy L.; Sarani, Babak; Sexton, Kevin W.; Beck, William C.; Milia, David; Hess, Joseph; Workman, Cheryl F.; Greenwell, Cynthia; Weaver, Melinda; Agrawal, Vaidehi; Amos, Joseph Darryl; Nance, Michael L.; Campbell, Marie; Dunn, Julie; Steen, Sara; McGonigal, Michael D.; Schroeppel, Thomas J.; Putty, Bradley; Sherar, Danielle; Flohr, Stephanie D.

doi:10.1016/j.injury.2020.09.027

Cited by 14 publications

(10 citation statements)

References 13 publications

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“…Knowing that a calculated ISS can identify how injured a patient might be, but does not take into account comorbidities or the resources to care for an injured patient, Roden-Foreman et al have suggested a tool additional to the CMM for standardizing and simplifying case reviews. 4 However, methods to assess the transferred patient population remain unclear. When a trauma center calculates its triage rates, there is no way to account for the transferred patients that, while still critically injured, may not require the full extent of resources as would be expected by their ISS, simply because they have already received some of them.…”

Section: Discussionmentioning

confidence: 99%

“…3 Roden-Foreman et al suggested that CMM alone is not adequate, although it can be useful in combination with additional measurements. 4 Finally, Peng and colleagues questioned the formulas used in CMM, and whether they actually measure what they claim to. 5 ACS-COT offers no specific guidance regarding the inclusion or exclusion of patients transferred from outside hospitals (OSHs) when calculating triage rates.…”

Section: Introductionmentioning

confidence: 99%

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Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

Seegert

Redfern

Chapman

et al. 2020

The American Surgeon™

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Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

Seegert

Redfern

Chapman

et al. 2020

The American Surgeon™

View full text Add to dashboard Cite

show abstract

“…Standard Triage Assessment Tool had significant associations with complications, discharge to a continuing care facility, and length of stay. 52 However, STAT may miss inappropriate triages as initial appropriate triages by CMM are not reevaluated. These cases may in fact not be appropriately triaged but do not initiate automatic review.…”

Section: Retrospective Triage Assessmentmentioning

confidence: 99%

“…A recent multi-institutional study found that hospital-overtriage and undertriage rates are less with STAT than CMM. Standard Triage Assessment Tool had significant associations with complications, discharge to a continuing care facility, and length of stay 52 . However, STAT may miss inappropriate triages as initial appropriate triages by CMM are not reevaluated.…”

Section: Retrospective Triage Assessmentmentioning

confidence: 99%

“…The elderly trauma patient with rib fractures triaged to a trauma call is appropriately triaged with CMM and undertriaged with NFTI. In addition, of the 491 mortalities examined by Roden-Foreman et al, 52 which were labeled as hospital undertriaged by CMM, 111 (22.6%) were reclassified as appropriately triaged by STAT. These patients may represent undertriage deaths, which will not be manually reviewed because of their reclassification as appropriate by STAT although would be captured in the secondary review required for all deaths.…”

Section: Retrospective Triage Assessmentmentioning

confidence: 99%

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Field-Triage, Hospital-Triage and Triage-Assessment: A Literature Review of the Current Phases of Adult Trauma Triage

Morris

Karam

Murphy

et al. 2021

J Trauma Acute Care Surg

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Despite major improvements in the United States trauma system over the past two decades, prehospital trauma triage is a significant challenge. Undertriage is associated with increased mortality, and overtriage results in significant resource overuse. The American College of Surgeons Committee on Trauma benchmarks for undertriage and overtriage are not being met. Many barriers to appropriate field triage exist, including lack of a formal definition for major trauma, absence of a simple and widely applicable triage mode, and emergency medical service adherence to triage protocols. Modern trauma triage systems should ideally be based on the need for intervention rather than injury severity. Future studies should focus on identifying the ideal definition for major trauma and creating triage models that can be easily deployed. This narrative review article presents challenges and potential solutions for prehospital trauma triage.

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Refining triage practices by predicting the need for emergent care following major trauma: the experience of a level 1 adult trauma center

Cohen

Mattar

Feigin

et al. 2022

Eur J Trauma Emerg Surg

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Avoiding Cribari gridlock 2: The standardized triage assessment tool outperforms the Cribari matrix method in 38 adult and pediatric trauma centers

Cited by 14 publications

References 13 publications

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

Field-Triage, Hospital-Triage and Triage-Assessment: A Literature Review of the Current Phases of Adult Trauma Triage

Refining triage practices by predicting the need for emergent care following major trauma: the experience of a level 1 adult trauma center

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