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

BackgroundOvertriage of trauma patients is unavoidable and requires effective use of hospital resources. A ‘pit stop’ (PS) was added to our lowest tier trauma resource (TR) triage protocol where the patient stops in the trauma bay for immediate evaluation by the emergency department (ED) physician and trauma nursing. We hypothesized this would allow for faster diagnostic testing and disposition while decreasing cost.MethodsWe performed a before/after retrospective comparison after PS implementation. Patients not meeting trauma activation (TA) criteria but requiring trauma center evaluation were assigned as a TR for an expedited PS evaluation. A board-certified ED physician and trauma/ED nurse performed an immediate assessment in the trauma bay followed by performance of diagnostic studies. Trauma surgeons were readily available in case of upgrade to TA. We compared patient demographics, Injury Severity Score, time to physician evaluation, time to CT scan, hospital length of stay, and in-hospital mortality. Comparisons were made using 95% CI for variance and SD and unpaired t-tests for two-tailed p values, with statistical difference, p<0.05.ResultsThere were 994 TAs and 474 TRs in the first 9 months after implementation. TR’s preanalysis versus postanalysis of the TR group shows similar mean door to physician evaluation times (6.9 vs. 8.6 minutes, p=0.1084). Mean door to CT time significantly decreased (67.7 vs. 50 minutes, p<0.001). 346 (73%) TR patients were discharged from ED; 2 (0.4%) were upgraded on arrival. When admitted, TR patients were older (61.4 vs. 47.2 years, p<0.0001) and more often involved in a same-level fall (59.5% vs. 20.1%, p<0.0001). Undertriage was calculated using the Cribari matrix at 3.2%.DiscussionPS implementation allowed for faster door to CT time for trauma patients not meeting activation criteria without mobilizing trauma team resources. This approach is safe, feasible, and simultaneously decreases hospital cost while improving allocation of trauma team resources.Level of evidenceLevel II, economic/decision therapeutic/care management study.

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“…The Cribari matrix has been questioned for overestimating overtriage and undertriage. 26 …”

Section: Discussionmentioning

confidence: 99%

Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients

Dandan

Tominaga

Zhao

et al. 2021

Trauma Surg Acute Care Open

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“…The STAT method combines the TTM with NFTI. 6 However, timely classification balancing resource consumption and injury severity is still needed. NFTI and STAT have significant drawbacks as they both miss important emergent interventions and include other patients unnecessarily based on delayed outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Given these concerns, the need for trauma intervention (NFTI) and the secondary triage assessment tool (STAT) has recently been proposed to measure TTA appropriateness. 6,7 Both definitions suffer from limitations. STAT includes the union of NFTI and TTM and thus suffers from all the same limitations of TTM.…”

Section: Introductionmentioning

confidence: 99%

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Redefining the Trauma Triage Matrix: The Role of Emergent Interventions

Morris

Davis

Koestner

et al. 2020

Journal of Surgical Research

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“…To the best of the authors' knowledge, the literature does not contain any studies that investigated undertriage in the geriatric population, as calculated by the Need for Trauma Intervention (NFTI) tool. The NFTI tool is a novel metric that performs a secondary review of trauma patients to determine the presence of major trauma [6,7]. This tool accounts for resource utilization and patient outcomes in combination with objectively measuring injuries.…”

Section: Methodsmentioning

confidence: 99%

Need for Trauma Intervention and Improving Under-Triaging in Geriatric Trauma Patients: Under-Triaged or Misclassified

Gabriel¹,

Kimberly²,

Siddhartha³

et al. 2022

Int J Crit Care Emerg Med

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Background: Combining the Need for Trauma Intervention (NFTI) calculation with the Cribari Matrix Method (CMM) more accurately determines appropriate triage, particularly of geriatric trauma patients. These patients (>/= age 65 years) have comorbidities, increased frailty, and decreased overall functional capacity. The CMM alone does not address their increased risk of mortality secondary to inappropriate or suboptimal care; performance improvement efforts to decrease the risk of under-triage have prompted the use of NFTI in this institution.Methods: Geriatric patients presenting to a level 1 trauma center and requiring full or limited trauma team activation or consultation from January 1, 2018 to January 31, 2020 were selected for this retrospective review; 79 undertriaged geriatric patients were included. Those categorized as under-triaged by CMM + Injury Severity Score (ISS) were then analyzed using the NFTI criteria. The hypothesis was that the percent of patients classified as under-triaged would be significantly less following the application of NFTI.Results: Application of NFTI criteria to patients classified as under-triaged by CMM + ISS reduced the study time period under-triage rate from 7.6% to 0.8% for 1,041 trauma activations (P < 0.0003) and 2.5% to 0.3% for 3,123 trauma admissions (P < 0.0003). Conclusion:This study provides evidence of the utility of NFTI-adjusted triage determination in more accurately identifying under-triaged geriatric trauma patients. Further, these results imply the benefit of applying NFTI earlier in the continuum of care, perhaps even requiring the initiation of formal process improvement.

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

Abstract: Prognostic, level III.

Cited by 25 publications

References 13 publications

Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients

Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients

Redefining the Trauma Triage Matrix: The Role of Emergent Interventions

Need for Trauma Intervention and Improving Under-Triaging in Geriatric Trauma Patients: Under-Triaged or Misclassified

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