Background It is argued that many older trauma patients are under-triaged in prehospital care which may adversely affect their outcomes. This systematic review aimed to assess prehospital under-triage rates for older trauma patients, the accuracy of the triage criteria, and the impact of prehospital triage decisions on outcomes. Methods A computerised literature search using MEDLINE, Scopus, and CINHAL databases was conducted for studies published between 1966 and 2021 using a list of predetermined index terms and their associated alternatives. Studies which met the inclusion criteria were included and critiqued using the Critical Appraisal Skills Programme tool. Due to the heterogeneity of the included studies, narrative synthesis was used in this systematic review. Results Of the 280 identified studies, 23 met the inclusion criteria. Current trauma triage guidelines have poor sensitivity to identify major trauma and the need for TC care for older adults. Although modified triage tools for this population have improved sensitivity, they showed significantly decreased specificity or were not applied to all older people. The issue of low rates of TC transport for positively triaged older patients is not well understood. Furthermore, the benefits of TC treatment for older patients remain uncertain. Conclusions This systematic review showed that under-triage is an ongoing issue for older trauma patients in prehospital care and its impact on their outcomes is still uncertain. Further high-quality prospective research is needed to assess the accuracy of prehospital triage criteria, the factors other than the triage criteria that affect transport decisions, and the impact of under-triage on outcomes.
Background Emergency care research into ‘Silver Trauma’, which is simply defined as major trauma consequent upon relatively minor injury mechanisms, is facing many challenges including that at present, there is no clear prioritisation of the issues. This study aimed to determine the top research priorities to guide future research. Methods This consensus-based prioritization exercise used a three-stage modified Delphi technique. The study consisted of an idea generating (divergent) first round, a ranking evaluation in the second round, and a (convergent) consensus meeting in the third round. Results A total of 20 research questions advanced to the final round of this study. After discussing the importance and clinical significance of each research question, five research questions were prioritised by the experts; the top three research priorities were: What are older people’s preferred goals of trauma care? Beyond the Emergency Department (ED), what is the appropriate combined geriatric and trauma care? Do older adults benefit from access to trauma centres? If so, do older trauma patients have equitable access to trauma centre compared to younger adults? Conclusion The results of this study will assist clinicians, researchers, and organisations that are interested in silver trauma in guiding their future efforts and funding toward addressing the identified research priorities.
Background:The proportions of older adults with major trauma is increasing. Highquality care for this population requires accurate and effective prehospital trauma triage decisions.Objectives: Anatomicalal and physiologicalal changes with age, comorbidities, and medications use for older adults may affect the accuracy of prehospital trauma triage. Materials and methods:This narrative review focuses on age-related anatomicalal and physiologicalal changes, comorbidities, and medications use for older adults with an emphasis on their impact on the accuracy of prehospital trauma triage tools. It also addresses efforts to develop alternative triage criteria to reduce under-triage.Results: These factors were shown to affect physiological responses to injury and mechanism of injury for older people. Current triage tools poorly predicted injury severity. Geriatric-specific physiologicalal measures and comorbidities significantly improved sensitivity with much lower specificity. Assessing anticoagulant or antiplatelet use in head injury notably improved sensitivity to identify traumatic intracranial haemorrhage, neurosurgery or death with modest decrease in specificity.Conclusions: Improving paramedics' knowledge about the challenges when assessing older people with silver trauma may reduce under-triage. Assessing frailty could help in predict injury severity. Future research is needed to improve triage decisions for this population.
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