医学
急诊分诊台
损伤严重程度评分
严重创伤
小儿外伤
修正创伤评分
急诊医学
医疗急救
伤害预防
毒物控制
作者
Miranda A. Chacon,Catherine W. Liu,Loralai Crawford,Hadassah Polydore,Tiffany Ting,Derek Wakeman,Nicole A. Wilson
标识
DOI:10.1097/xcs.0000000000001044
摘要
Background: Assigning trauma team activation levels for trauma patients is a classification task that machine learning models can help optimize. However, performance is dependent upon the “ground-truth” labels used for training. Our purpose was to investigate two ground-truths, the Cribari matrix and the Need for Trauma Intervention (NFTI), for labeling training data. Study Design: Data was retrospectively collected from the institutional trauma registry and electronic medical record, including all pediatric patients (age <18 y) who triggered a trauma team activation (1/2014 – 12/2021). Three ground-truths were used to label training data: 1) Cribari (Injury Severity Score >15 = full activation), 2) NFTI (positive for any of 6 criteria = full activation), and 3) the union of Cribari+NFTI (either positive = full activation). Results: Of 1,366 patients triaged by trained staff, 143 (10.47%) were considered under-triaged using Cribari, 210 (15.37%) using NFTI, and 273 (19.99%) using Cribari+NFTI. NFTI and Cribari+NFTI were more sensitive to under-triage in patients with penetrating mechanisms of injury (p = 0.006), specifically stab wounds (p = 0.014), compared to Cribari, but Cribari indicated over-triage in more patients who required prehospital airway management (p < 0.001), CPR (p = 0.017), and who had mean lower GCS scores on presentation (p < 0.001). The mortality rate was higher in the Cribari over-triage group (7.14%, n = 9) compared to NFTI and Cribari+NFTI (0.00%, n = 0, p = 0.005). Conclusion: To prioritize patient safety, Cribari+NFTI appears best for training a machine learning algorithm to predict trauma team activation level.
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