Need for Emergent Intervention within 6 Hours: A Novel Prediction Model for Hospital Trauma Triage

Rachel S Morris, Basil S. Karam, Emily J. Zolfaghari, Benjamin Chen, Thomas Kirsh, Roshan Tourani, David J. Milia, Lena Napolitano, Marc de Moya, Marc Conterato, Constantin Aliferis, Sisi Ma, Christopher Tignanelli

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: A tiered trauma team activation system allocates resources proportional to patients’ needs based upon injury burden. Previous trauma hospital-triage models are limited to predicting Injury Severity Score which is based on > 10% all-cause in-hospital mortality, rather than need for emergent intervention within 6 hours (NEI-6). Our aim was to develop a novel prediction model for hospital-triage that utilizes criteria available to the EMS provider to predict NEI-6 and the need for a trauma team activation. Methods: A regional trauma quality collaborative was used to identify all trauma patients ≥ 16 years from the American College of Surgeons-Committee on Trauma verified Level 1 and 2 trauma centers. Logistic regression and random forest were used to construct two predictive models for NEI-6 based on clinically relevant variables. Restricted cubic splines were used to model nonlinear predictors. The accuracy of the prediction model was assessed in terms of discrimination. Results: Using data from 12,624 patients for the training dataset (62.6% male; median age 61 years; median ISS 9) and 9,445 patients for the validation dataset (62.6% male; median age 59 years; median ISS 9), the following significant predictors were selected for the prediction models: age, gender, field GCS, vital signs, intentionality, and mechanism of injury. The final boosted tree model showed an AUC of 0.85 in the validation cohort for predicting NEI-6. Conclusions: The NEI-6 trauma triage prediction model used prehospital metrics to predict need for highest level of trauma activation. Prehospital prediction of major trauma may reduce undertriage mortality and improve resource utilization.

Original languageEnglish (US)
JournalPrehospital Emergency Care
Early online dateAug 18 2021
DOIs
StatePublished - Aug 18 2021

Bibliographical note

Publisher Copyright:
© 2021 National Association of EMS Physicians.

Keywords

  • resource allocation
  • trauma
  • triage

PubMed: MeSH publication types

  • Journal Article

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