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Avoiding Cribari gridlock 2: The standardized triage assessment tool outperforms the Cribari matrix method in 38 adult and pediatric trauma centers. Injury 2021 Mar;52(3):443-449



Pubmed ID




Scopus ID

2-s2.0-85091234894 (requires institutional sign-in at Scopus site)   4 Citations


OBJECTIVES: The Cribari Matrix Method (CMM) is the current standard to identify over/undertriage but requires manual trauma triage reviews to address its inadequacies. The Standardized Triage Assessment Tool (STAT) partially emulates triage review by combining CMM with the Need For Trauma Intervention, an indicator of major trauma. This study aimed to validate STAT in a multicenter sample.

METHODS: Thirty-eight adult and pediatric US trauma centers submitted data for 97,282 encounters. Mixed models estimated the effects of overtriage and undertriage versus appropriate triage on the odds of complication, odds of discharge to a continuing care facility, and differences in length of stay for both CMM and STAT. Significance was assessed at p <0.005.

RESULTS: Overtriage (53.49% vs. 30.79%) and undertriage (17.19% vs. 3.55%) rates were notably lower with STAT than with CMM. CMM and STAT had significant associations with all outcomes, with overtriages demonstrating lower injury burdens and undertriages showing higher injury burdens than appropriately triaged patients. STAT indicated significantly stronger associations with outcomes than CMM, except in odds of discharge to continuing care facility among patients who received a full trauma team activation where STAT and CMM were similar.

CONCLUSIONS: This multicenter study strongly indicates STAT safely and accurately flags fewer cases for triage reviews, thereby reducing the subjectivity introduced by manual triage determinations. This may enable better refinement of activation criteria and reduced workload.

Author List

Roden-Foreman JW, Rapier NR, Foreman ML, Cribari C, Parsons M, Zagel AL, Cull J, Coniglio RA, McGraw C, Blackmore AR, Lyell CA, Adams CA Jr, Lueckel SN, Regner JL, Holzmacher J, Sarani B, Sexton KW, Beck WC, Milia DJ, Hess JC, Workman CF, Greenwell C, Weaver M, Agrawal V, Amos JD, Nance ML, Campbell M, Dunn J, Steen S, McGonigal MD, Schroeppel TJ, Putty B, Sherar D, Flohr SD


David J. Milia MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Injury Severity Score
Patient Discharge
Retrospective Studies
Trauma Centers
Wounds and Injuries