Geriatric-Specific Triage Criteria Are More Sensitive Than Standard Adult Criteria in Identifying Need for Trauma Center Care in Injured Older Adults

Ichwan, Brian; Darbha, Subrahmanyam; Shah, Manish N.; Thompson, Laura; Evans, David C.; Boulger, Creagh; Caterino, Jeffrey M.

doi:10.1016/j.annemergmed.2014.04.019

Cited by 99 publications

(132 citation statements)

References 24 publications

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“…Often occult injuries are more difficult to recognize and patients can decompensate unexpectedly with little warning.” However, neither this protocol nor the CDC’s field trauma triage criteria includes age as an explicit trigger for EMS transport. Further, these and other geriatric specific trauma triage criteria distinguish between patients who require trauma center evaluation vs. non-trauma center evaluation 24,25 . These criteria do not help EMS providers distinguish between older adults who require some form of additional medical evaluation vs. no further evaluation after trauma, and we were unable to find any published criteria which provide guidance in making this distinction.…”

Section: Discussionmentioning

confidence: 99%

Ambulance transport rates after motor vehicle collision for older vs. younger adults: A population-based study

Hunold

Sochor

McLean

et al. 2014

Accident Analysis & Prevention

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Older adults are at greater risk than younger adults for life-threatening injury after motor vehicle collision (MVC). Among those with life-threatening injury, older adults are also at greater risk of not being transported by emergency medical services (EMS) to an emergency department. Despite the greater risk of serious injury and non-transportation among older adults, little is known about the relationship between patient age and EMS transportation rates for individuals experiencing MVC. We describe transport rates across the age-span for adults seen by EMS after experiencing MVC using data reported to the North Carolina Department of Motor Vehicles between 2008 and 2011. Of all adults aged 18 years and older experiencing MVC and seen by EMS (N=484,310), 36.3% (N=175,768) were transported to an emergency department. Rates of transport for individuals seen by EMS after MVC increased only a small amount with increasing patient age. After adjusting for potential confounders of the relationship between patient age and the decision to transport (patient gender, patient race, air bag deployment, patient trapped or ejected, and injury severity), transport rates were: age 18–64 = 36.0% (95% Confidence Interval [CI], 35.9%–36.2%); age 65–74 = 36.6% (95% CI, 36.0%–37.1%); age 75–84 = 37.3% (95% CI, 36.5%–38.1%), and age 85–94 = 38.2% (95% CI, 36.7%–39.8%). In North Carolina between 2008 and 2011, the transportation rate was only slightly higher for older adults than for younger adults, and most older adults experiencing MVC and seen by EMS were not transported to the emergency department. These findings have implications for efforts to improve the sensitivity of criteria used by EMS to determine the need for transport for older adults experiencing MVC.

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Section: Discussionmentioning

confidence: 99%

Ambulance transport rates after motor vehicle collision for older vs. younger adults: A population-based study

Hunold

Sochor

McLean

et al. 2014

Accident Analysis & Prevention

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“…Falls in the elderly have significant morbidity and mortality and are very costly 28 . Geriatric-specific triage criteria and development of geriatric trauma centers may reduce morbidity and mortality of geriatric trauma 29,30 . Many falls could be prevented by defining their risk factors 31 .…”

Section: Many Elderly Whomentioning

confidence: 99%

Geriatric fall-related injuries

Hefny¹,

Abbas²,

Abu‐Zidan³

2016

Afr H. Sci.

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Background: Falls are the leading cause of geriatric injury. Objectives: We aimed to study the anatomical distribution, severity, and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. Methods: All injured patients with an age ≥ 60 years who were admitted to Al-Ain Hospital or died in the Emergency Department due to falls were prospectively studied over a four year period. Results: We studied 92 patients. Fifty six of them (60.9%) were females. The mean (standard deviation) of age was 72.2 (9.6) years. Seventy three (89%) of all incidents occurred at home. Eighty three patients (90.2%) fell on the same level. The median (range) ISS was 4 (1-16) and the median GCS (range) was 15 (12-15). The lower limb was the most common injured body region (63%). There were no statistical significant differences between males and females regarding age, ISS, and hospital stay (p = 0.85, p = 0.57, and p = 0.35 respectively). Conclusion:The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk factors for falls including home hazards is essential for prevention of geriatric fall-related injuries.

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“…7 Treatment is further complicated by factors such as heart rate and blood pressure, which distinguish severe cases among other adult populations but may become unreliable indicators among older adults. [9][10][11] This confluence of factors has resulted in identified patterns of undertriage associated with poorer outcomes 9,12-15 such as higher rates of trauma-related morbidity and mortality among older patients. [16][17][18] Possible causes for these age-related triage disparities include patient-level variables such as payer status, 19 differences in initial presentation, 2,19,20 location of injury, 21 type of injury, 22 and geographic distance from the nearest emergency department (ED).…”

Section: Discussionmentioning

confidence: 99%

“…25 Studies of triage patterns during the years following that revision suggest that the age-based criterion introduced in 2006 was inadequate 12,18,25 and that additional age-based criteria would improve field triage of patients aged 70 years and older. 9 There have been few evaluations of the 2011 revision. Most studies used data collected prior to 2010.…”

Section: Discussionmentioning

confidence: 99%

Age‐related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

Flottemesch

Raetzman

Heslin

et al. 2017

Academic Emergency Medicine

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ObjectiveIn 2006, the American College of Surgeons’ Committee on Trauma and the Centers for Disease Control and Prevention released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age‐based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions.MethodsA pre‐post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases with multivariable logistic regressions considered changes in 1) the trauma designation of the emergency department where treatment was initiated and 2) transfer to a TC following initial treatment at a non‐TC.ResultsCompared with adults aged 18 to 44 years, after multivariable adjustment, in both years TC care was less likely for adults aged 45 to 64 years (odds ratio [OR] = 0.76 in 2009 and 0.74 in 2012), aged 65 to 84 years (OR = 0.61 and 0.59), and aged 85+ years (OR = 0.53 and 0.56). Between 2009 and 2012, the likelihood of TC care increased for all age groups, with the largest increase among those aged 85+ years (OR = 1.18), which was statistically different (p = 0.02) from the increase among adults aged 18 to 44 years (OR = 1.12). The analysis of transfers yielded similar results.ConclusionsAlthough patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age‐based disparities persisted.

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Geriatric-Specific Triage Criteria Are More Sensitive Than Standard Adult Criteria in Identifying Need for Trauma Center Care in Injured Older Adults

Cited by 99 publications

References 24 publications

Ambulance transport rates after motor vehicle collision for older vs. younger adults: A population-based study

Ambulance transport rates after motor vehicle collision for older vs. younger adults: A population-based study

Geriatric fall-related injuries

Age‐related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

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