Evaluating Age in the Field Triage of Injured Persons

Abstract

Study Objective In this study, we evaluated (1) trauma under-triage by age group; (2) the association between age and serious injury after accounting for other field triage criteria and confounders; and (3) the potential impact of a mandatory age triage criterion for field triage. Methods This was a retrospective cohort study of injured children and adults transported by 48 EMS agencies to 105 hospitals in 6 regions of the Western U.S. from 2006 through 2008. We used probabilistic linkage to match EMS records to hospital records, including: trauma registries, state discharge databases and emergency department databases. The primary outcome measure was serious injury, as measured by an Injury Severity Score (ISS) ≥ 16. We assessed under-triage (ISS ≥ 16 and triage-negative or transport to a non-trauma center) by age decile and used multivariable logistic regression models to estimate the association (linear and non-linear) between age and ISS ≥ 16, adjusted for important confounders. We also evaluated the potential impact of age on triage efficiency and trauma center volume. Results 260,027 injured patients were evaluated and transported by EMS over the 3-year study period. Under-triage increased for patients over 60 years of age, reaching approximately 60% for those older than 90 years. There was a strong non-linear association between age and ISS ≥ 16. For patients not meeting other triage criteria, the probability of serious injury was most notable after 60 years. A mandatory age triage criterion would have decreased under-triage at the expense of over-triage, with one ISS ≥ 16 patient identified for every 60–65 additional patients transported to major trauma centers. Conclusion Trauma under-triage increases in patients older than 60 years. While the probability of serious injury increases among triage-negative patients with increasing age, the use of a mandatory age triage criterion appears inefficient for improving field triage.

Older patients with traumatic brain injury present with a higher GCS score than younger patients for a given severity of injury

“…Many field triage guidelines are based on a combination of anatomical injury, mechanism of injury and vital signs (including GCS). The sensitivity of such tools for identifying major trauma has been reported to decrease with age 12. Recent work by ourselves and others suggests that for a given anatomical severity of TBI, the elderly may present with a higher GCS than younger patients 13 14.…”

Sustaining A Coordinated, Regional Approach To Trauma And Emergency Care Is Critical To Patient Health Care Needs

“…However, they may be a result of patients' preferences or of the inadequacy of current triage criteria to identify the older patient who is in need of higher-level care. 31,32 At the same time, it is unclear whether the elderly truly benefit from treatment at a Level I center. 19 Further research is needed to develop evidence-based guidelines in this area, especially in light of the growing number of older adults who are injured.…”

The trade-offs in field trauma triage: A multiregion assessment of accuracy metrics and volume shifts associated with different triage strategies

“…8 However, the feasibility of reaching these benchmarks and the resulting implications for trauma systems remain unclear. Recent literature suggests that the benchmark for under-triage is not being met, [10][11][12][13][14][15] particularly among older adults, and it remains unknown whether the guidelines could be revised to meet these accuracy targets. It is also uncertain how changes in triage accuracy may impact the volume of injured patients transported to different types of hospitals.…”