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SEQIC Indicator 10 – Trauma Team Activation Appropriateness

Source: R/seqic_10.R
seqic_indicator_10.Rd

[Experimental]

Calculates three trauma system quality indicators related to trauma team activations where the patient was kept at the facility:

  • 10a: Proportion of patients meeting triage criteria (based on Injury Severity Score or Need For Trauma Intervention) who received low-level or no activation (undertriage).

  • 10b: Proportion of patients not meeting triage criteria who received highest-level trauma activation (overtriage).

  • 10c: Proportion of major trauma patients receiving a full activation (undertriage via Peng & Xiang, 2019).

    (10a, 10b, 10c can be based on Injury Severity Score or Need For Trauma Intervention based on user choice)

Users may stratify results by one or more grouping variables and optionally compute confidence intervals.

Usage

seqic_indicator_10(
  data,
  level,
  included_levels = c("I", "II", "III", "IV"),
  unique_incident_id,
  transfer_out_indicator,
  trauma_team_activation_level,
  iss,
  nfti,
  groups = NULL,
  calculate_ci = NULL,
  ...
)

Arguments

data

A data frame containing trauma incident records.

level

Column indicating the trauma center designation level (e.g., I, II, III, IV).

included_levels

Character vector indicating what facility levels to include in the analysis. Defaults to c("I", "II", "III", "IV").

unique_incident_id

Unique identifier for each record.

transfer_out_indicator

Column name indicating whether the patient was transferred out of the initial trauma center to definitive care. Logical, character, or factor type. Values representing "No" (e.g., FALSE, "No") indicate no transfer out.

trauma_team_activation_level

Column indicating the trauma team activation level (e.g., "Level 1", "Level 2", "Level 3", "Consultation"). Must be character or factor.

iss

Optional numeric column representing the Injury Severity Score.

nfti

Optional column indicating Need For Trauma Intervention classification of positive or negative. Should be character, factor, or logical.

groups

Optional character vector of column names used for grouping results.

calculate_ci

Optional; if not NULL, must be "wilson" or "clopper-pearson" to compute confidence intervals.

...

Arguments passed on to nemsqar::nemsqa_binomial_confint

conf.level

Numeric value between 0 and 1 indicating the confidence level. Defaults to 0.95 (95% confidence interval).

correct

Logical, indicating whether to apply continuity correction for Wilson intervals. Defaults to TRUE.

Value

A list of two tibbles with counts and proportions for SEQIC Indicators 10a, 10b, and 10c, along with model diagnostics for the Cribari or NFTI ouputs. The proportions in 10a, 10b, and 10c will optionally include 95% confidence intervals.

Details

This function:

  • Restricts analysis to Level I–IV trauma centers.

  • Removes duplicate incidents using unique_incident_id.

  • Classifies each record as meeting or not meeting triage criteria based on ISS or NFTI logic.

  • Optionally computes 95% confidence intervals for each indicator.

Users must ensure appropriate column names are passed and data is pre-processed to include the necessary fields without missing critical identifiers or timestamps.

References

Beam G, Gorman K, Nannapaneni S, Zipf J, Simunich T, et al. (2022) Need for Trauma Intervention and Improving Under-Triaging in Geriatric Trauma Patients: undertriaged or Misclassified. Int J Crit Care Emerg Med 8:136. doi.org/10.23937/2474-3674/1510136

Peng J, Xiang H. Trauma undertriage and overtriage rates: are we using the wrong formulas? Am J Emerg Med. 2016 Nov;34(11):2191-2192. doi: 10.1016/j.ajem.2016.08.061. Epub 2016 Aug 31. PMID: 27615156; PMCID: PMC6469681.

Roden-Foreman JW, Rapier NR, Yelverton L, Foreman ML. Asking a Better Question: Development and Evaluation of the Need For Trauma Intervention (NFTI) Metric as a Novel Indicator of Major Trauma. J Trauma Nurs. 2017 May/Jun;24(3):150-157. doi: 10.1097/JTN.0000000000000283. PMID: 28486318.

Author

Nicolas Foss, Ed.D., MS

Examples

# Packages
library(dplyr)
library(traumar)

# Simulated data for SEQIC Indicator 10
test_data <- tibble::tibble(
  id = as.character(1:12),
  trauma_level = c("I", "II", "III", "IV", "II", "I", "IV", "III", "II", "I",
  "III", "IV"),
  activation = c("Level 1", "Level 2", "None", "Consultation", "Level 1",
  "Level 1", "None", "Level 3", "Level 1", "Consultation", "None", "Level
  2"),
  acute_transfer = rep("No", 12),
  iss = c(25, 10, 16, 8, 30, 45, 12, 9, 28, 6, 17, 14),
  nfti = c(TRUE, FALSE, TRUE, FALSE, TRUE, TRUE, FALSE, FALSE, TRUE, FALSE,
  TRUE, TRUE),
  region = rep(c("East", "West"), each = 6)
)

# Run the function, this will succeed
traumar::seqic_indicator_10(
  data = test_data,
  level = trauma_level,
  included_levels = c("I", "II", "III", "IV"),
  unique_incident_id = id,
  transfer_out_indicator = acute_transfer,
  trauma_team_activation_level = activation,
  iss = iss,
  nfti = NULL,
  groups = "region",
  calculate_ci = "wilson"
)
#> $seqic_10
#> # A tibble: 2 × 17
#>   triage_logic region numerator_10a denominator_10a seqic_10a lower_ci_10a
#>   <chr>        <chr>          <int>           <int>     <dbl>        <dbl>
#> 1 cribari      East               1               3     0.333       0.0177
#> 2 cribari      West               1               5     0.2         0.0105
#> # ℹ 11 more variables: upper_ci_10a <dbl>, numerator_10b <int>,
#> #   denominator_10b <int>, seqic_10b <dbl>, lower_ci_10b <dbl>,
#> #   upper_ci_10b <dbl>, numerator_10c <int>, denominator_10c <int>,
#> #   seqic_10c <dbl>, lower_ci_10c <dbl>, upper_ci_10c <dbl>
#> 
#> $diagnostics
#> # A tibble: 2 × 15
#>   triage_logic region full_minor full_major limited_minor limited_major     N
#>   <chr>        <chr>       <int>      <int>         <int>         <int> <int>
#> 1 cribari      East            0          3             1             1     5
#> 2 cribari      West            0          1             1             1     3
#> # ℹ 8 more variables: sensitivity <dbl>, specificity <dbl>,
#> #   positive_predictive_value <dbl>, negative_predictive_value <dbl>,
#> #   false_negative_rate <dbl>, false_positive_rate <dbl>,
#> #   false_discovery_rate <dbl>, false_omission_rate <dbl>
#> 

# Run the function, this will fail
try(
  traumar::seqic_indicator_10(
  data = test_data,
  level = trauma_level,
  included_levels = c("I", "II", "III", "IV"),
  unique_incident_id = id,
  transfer_out_indicator = acute_transfer,
  trauma_team_activation_level = activation,
  iss = iss,
  nfti = nfti,
  groups = "region",
  calculate_ci = "wilson"
))
#> Error in traumar::seqic_indicator_10(data = test_data, level = trauma_level,  : 
#>   Please supply exactly one of `iss` or `nfti`.