@article{ref1,
title="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",
journal="Journal of trauma and acute care surgery",
year="2019",
author="Roden-Foreman, Jacob W. and Rapier, Nakia R. and Foreman, Michael L. and Zagel, Alicia L. and Sexton, Kevin W. and Beck, William C. and McGraw, Constance and Coniglio, Raymond A. and Blackmore, Abigail R. and Holzmacher, Jeremy and Sarani, Babak and Hess, Joseph C. and Greenwell, Cynthia and Adams, Charles A. and Lueckel, Stephanie N. and Weaver, Melinda and Agrawal, Vaidehi and Amos, Joseph D. and Workman, Cheryl F. and Milia, David J. and Bertelson, Annette and Dorlac, Warren and Warne, Maria J. and Cull, John and Lyell, Cassie A. and Regner, Justin L. and McGonigal, Michael D. and Flohr, Stephanie D. and Steen, Sara and Nance, Michael L. and Campbell, Marie and Putty, Bradley and Sherar, Danielle and Schroeppel, Thomas J.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
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. <br><br>METHODS: Thirty-eight adult and pediatric U.S. trauma centers submitted data for 88,488 encounters. Mixed models tested ISS >15, RTS <7.84, and NFTI's associations with complications, survivors' discharge to continuing care, and survivors' length of stay (LOS). <br><br>RESULTS: NFTI had stronger associations with complications and LOS than ISS and RTS (odds ratios (99.5% CI): 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% CI): 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% CI): 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>15 or RTS<7.84. <br><br>CONCLUSIONS: 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 >15 and RTS <7.84. Using NFTI may improve retrospective triage monitoring and statistical risk adjustments. LEVEL OF EVIDENCE: III, Therapeutic.<p /> <p>Language: en</p>",
language="en",
issn="2163-0755",
doi="10.1097/TA.0000000000002402",
url="http://dx.doi.org/10.1097/TA.0000000000002402"
}