TY  - JOUR
PY  - 2019//
TI  - 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
JO  - Journal of trauma and acute care surgery
A1  - Roden-Foreman, Jacob W.
A1  - Rapier, Nakia R.
A1  - Foreman, Michael L.
A1  - Zagel, Alicia L.
A1  - Sexton, Kevin W.
A1  - Beck, William C.
A1  - McGraw, Constance
A1  - Coniglio, Raymond A.
A1  - Blackmore, Abigail R.
A1  - Holzmacher, Jeremy
A1  - Sarani, Babak
A1  - Hess, Joseph C.
A1  - Greenwell, Cynthia
A1  - Adams, Charles A.
A1  - Lueckel, Stephanie N.
A1  - Weaver, Melinda
A1  - Agrawal, Vaidehi
A1  - Amos, Joseph D.
A1  - Workman, Cheryl F.
A1  - Milia, David J.
A1  - Bertelson, Annette
A1  - Dorlac, Warren
A1  - Warne, Maria J.
A1  - Cull, John
A1  - Lyell, Cassie A.
A1  - Regner, Justin L.
A1  - McGonigal, Michael D.
A1  - Flohr, Stephanie D.
A1  - Steen, Sara
A1  - Nance, Michael L.
A1  - Campbell, Marie
A1  - Putty, Bradley
A1  - Sherar, Danielle
A1  - Schroeppel, Thomas J.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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>
LA  - en
SN  - 2163-0755
UR  - http://dx.doi.org/10.1097/TA.0000000000002402
ID  - ref1
ER  -