Diagnostic accuracy of prehospital triage tools for identifying major trauma in elderly injured patients: A systematic review

Fuller, Gordon; Pandor, Abdullah; Essat, Munira; Sabir, L.; Buckley‐Woods, Helen; Chatha, Hridesh; Holt, Chris; Keating, Samuel; Turner, Janette

doi:10.1097/ta.0000000000003039

Cited by 29 publications

(25 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2). After obtaining and reviewing full-text articles, 10 studies were excluded as they were not original research (literature review, articles, and editorial) [27][28][29][30], not focused in evaluating prehospital triage [10,[31][32][33], assessed a specific injury mechanism [34], or used the same data of another included study [35]. The quality assessment of the remaining 23 articles was performed independently by two reviewers.…”

Section: Resultsmentioning

confidence: 99%

Under-triage of older trauma patients in prehospital care: a systematic review

2021

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Under-triage of older trauma patients in prehospital care: a systematic review

2021

View full text Add to dashboard Cite

show abstract

“…This is a matter of great interest internationally, and this includes surveillance of literature and implementation of changes if justified. A recent systematic review of elderly-specific triage criteria found no studies that could demonstrate undertriage levels below the 5% recommended by American College of Surgeons Committee on Trauma 17,37 . Third, use of video assisted EMDC triage, recently deployed at most EMDCs in Norway, should be encouraged and assessed according to dispatch precision.…”

Section: Discussionmentioning

confidence: 99%

Differences in time-critical interventions and radiological examinations between adult and older trauma patients: A national register-based study

Cuevas-Østrem

Wisborg

Røise

et al. 2022

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND:Older trauma patients are reported to receive lower levels of care than younger adults. Differences in clinical management between adult and older trauma patients hold important information about potential trauma system improvement targets. The aim of this study was to compare prehospital and early in-hospital management of adult and older trauma patients, focusing on timecritical interventions and radiological examinations. METHODS: Retrospective analysis of the Norwegian Trauma Registry for 2015 through 2018. Trauma patients 16 years or older met by a trauma team and with New Injury Severity Score of 9 or greater were included, dichotomized into age groups 16 years to 64 years and 65 years or older. Prehospital and emergency department clinical management, advanced airway management, chest decompression, and admission radiological examinations was compared between groups applying descriptive statistics and appropriate statistical tests. RESULTS:There were 9543 patients included, of which 28% (n = 2711) were 65 years or older. Older patients, irrespective of injury severity, were less likely attended by a prehospital doctor/paramedic team (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.57-0.71), conveyed by air ambulance (OR, 0.65; 95% CI, 0.58-0.73), and transported directly to a trauma center (OR, 0.86; 95% CI, 0.79-0.94). Time-critical intervention and primary survey radiological examination rates only differed between age groups among patients with New Injury Severity Score of 25 or greater, showing lower rates for older adults (advanced airway management: OR, 0.60; 95% CI, 0.47-0.76; chest decompression: OR, 0.46; 95% CI, 0.25-0.85; x-ray chest: OR, 0.54; 95% CI, 0.39-0.75; x-ray pelvis: OR, 0.69; 95% CI, 0.57-0.84). However, for the patients attended by a doctor/paramedic team, there were no management differences between age groups. CONCLUSION:Older trauma patients were less likely to receive advanced prehospital care compared with younger adults. Older patients with very severe injuries received fewer time-critical interventions and radiological examinations. Improved dispatch of doctor/paramedic teams to older adults and assessment of the impact the observed differences have on outcome are future research priorities.

show abstract

“…This is consistent with the findings of the CENTER TBI study. The challenge of accurately triaging older patients is well recognised (19)(20)(21)(22)(23)(24)(25), and the poor accuracy of all current methods was the finding of a recent systematic review (26). This may be explained by the different pathophysiology of traumatic brain injury in the two cohorts, highlighted by the greater likelihood of intracranial injury in the low energy cohort yet a higher presenting GCS (Table 3) (18).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

The changing major trauma disease burden from low falls in the first two decades of the 21st Century – a longitudinal analysis from the largest European Trauma Registry

Shanahan

Tonkins

Bouamra

et al. 2022

Preprint

View full text Add to dashboard Cite

ObjectiveThe 21st century has seen an unexpected rise in numbers of patients with severe injuries caused by low energy transfer mechanisms such as low falls. Our objective was to determine whether this increasing “low energy transfer major trauma” disease burden is more strongly associated with population ageing, better detection or registry reporting between 2000 and 2019.DesignLongitudinal series of annual cross-sectional studies from the Trauma Audit Research Network (TARN).SettingEngland and Wales.ParticipantsPatients with an Injury Severity score (ISS) >15, admitted to English or Welsh hospitals from January 2000 until December 2019.Main outcome measuresThe primary outcome was the strength of association of changes in annual rates of; major trauma patients receiving three-dimensional imaging (CT/MRI scans), registry reporting, and proportion of the population aged over seventy-five with changes in the annual proportion of patients injured via low energy transfer mechanisms.ResultsThe annual proportion of major trauma patients injured by low energy transfer mechanisms rose more than four-fold from 12.5% in 2000 to 52.6% in 2019 (+40.1%, 95% CI 38.8 to 41.4, p<0.0001). This rise in the prevalence of low energy major trauma was more strongly associated with case ascertainment improvements over the study period - indicated by a 60% increase in the proportion of major trauma patients receiving CT/MRI (+60%), and 47% increase in registry reporting rates than a one percent rise in the prevalence of people aged 75 years and over in England and Wales.ConclusionBetween 2000 and 2019 changes in major trauma imaging and reporting have revealed the previously hidden burden of injury resulting from low energy transfer mechanisms, potentially explaining significant increases in major trauma patient numbers. Future research should recognise low energy and high energy major trauma patients are distinct groups and require different interventions to improve patient outcomes.Section 1: What is already known on this topicFalls from standing height or less than two metres are causing an increasing major injury disease burden across Europe.Internationally trauma systems have focussed on patients with injuries caused by high energy transfer mechanisms, such as road traffic collisions.Section 2: What this study addsBetter detection and reporting of low energy transfer major trauma - rather than population ageing - appear to be are driving the increase in lower energy major trauma.Low energy transfer major trauma - characterised by older age, less abnormal physiology, but a high prevalence of traumatic brain and thoracic injuries - is now the dominant major trauma (ISS>15) presentation in England and Wales.Low energy transfer major trauma patients wait longer for CT scan, are less likely to receive the care in the highest-level trauma centre, to undergo surgery or be admitted to critical care.Section 3: How this study might affect research, policy and practiceFuture research should recognise high energy and low energy trauma patients are distinct groups, which require different interventions to improve care processes and outcomes.

show abstract

Diagnostic accuracy of prehospital triage tools for identifying major trauma in elderly injured patients: A systematic review

Abstract: This is a repository copy of Diagnostic accuracy of prehospital triage tools for identifying major trauma in elderly injured patients: A systematic review.

Cited by 29 publications

References 42 publications

Under-triage of older trauma patients in prehospital care: a systematic review

Under-triage of older trauma patients in prehospital care: a systematic review

Differences in time-critical interventions and radiological examinations between adult and older trauma patients: A national register-based study

The changing major trauma disease burden from low falls in the first two decades of the 21st Century – a longitudinal analysis from the largest European Trauma Registry

Contact Info

Product

Resources

About