Should Age Be a Factor to Change From a Level II to a Level I Trauma Activation?

Shifflette, Vanessa; Lorenzo, Manuel; Mangram, Alicia; Truitt, Michael S.; Amos, Joseph Darryl; Dunn, Erica H.

doi:10.1097/ta.0b013e3181e291e9

Cited by 50 publications

(30 citation statements)

References 20 publications

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“…4 Data from the National Trauma Databank have shown that elderly trauma patients have a threefold increase in morbidity and a fivefold increase in mortality with minor ISS, whereas they have a twofold increase in morbidity and a fourfold increase in mortality with major ISS. 5 Another study showed an 11.4% mortality rate in trauma patients age older than 65 years compared with patients aged 18 to 35 years who only had a mortality rate of 2.4%. 4 The trauma death rate per 100,000 people per year is 56.0 for all age groups combined.…”

Section: Discussionmentioning

confidence: 97%

“…2,4 Geriatric trauma patients have significantly worse outcomes compared with younger patients. 5 Therefore, trauma care given to these patients should be distinctively different from care given to their younger cohorts. Thus, the purpose of this study was to evaluate the effectiveness of a multidisciplinary trauma service model (G-60) aimed at improving elderly trauma patient outcomes.…”

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confidence: 99%

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Geriatric trauma service

Mangram

Mitchell

Shifflette

et al. 2012

The Journal of Trauma and Acute Care Surgery

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Geriatric trauma service

Mangram

Mitchell

Shifflette

et al. 2012

The Journal of Trauma and Acute Care Surgery

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“…Ideally, patients with major trauma are triaged to the highest level of trauma care, that is, a level I trauma team activation (TTA), based on triage guidelines. However, some patients who present with certain risk factors are not assigned a level I TTA despite the severity of injuries 8. The group of patients with an ISS >15 who do not receive level I TTA are termed “undertriaged”.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

Barsi

Harris

Menaik

et al. 2016

OAEM

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PurposeThe primary objective of this study was to determine the risk factors associated with undertriage and the risk factors for mortality among the undertriaged patients at a level I safety-net trauma center.MethodsA retrospective analysis was performed of all trauma patients who presented to a level I safety-net trauma center with an injury severity score >15 over a 2-year period (2013–2014). Univariate and multivariate regression analyses were used to determine the risk factors predictive of undertriage in major trauma patients (injury severity score >15) and of mortality in undertriaged patients.ResultsDuring the 2-year study period, 334 of 2,485 admitted trauma patients presented with major trauma and were included in our study. From the univariate analysis, variables that were found to be independently associated with mortality in undertriaged patients included intubation, Glasgow Coma Scale score, revised trauma score, and dementia. Independent risk factors that were found to be significantly associated with undertriage in severely injured trauma patients included Glasgow Coma Scale score, motor vehicle crash, falls, revised trauma score, systolic blood pressure, heart rate, intubation, and dementia. When a multivariate analysis was performed to evaluate the statistically significant risk factors, dementia was found to be significantly associated with undertriage in severely injured trauma patients.ConclusionSeverely injured trauma patients with dementia are at significant risk for undertriage. Early identification of these risk factors while triaging at a level I safety-net trauma center could translate into improved patient outcomes following severe trauma.

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“…Interestingly, we found that older age was associated with the nonuse of the call center and delay in time to definitive care. Shifflette et al 9 found that geriatric patients have worse outcomes, even with minimal injury (ISS G 15) and suggest that patients older than 60 years be activated at the highest level. The lack of call center use and outcomes in this patient population need further exploration.…”

Section: Discussionmentioning

confidence: 98%

The effectiveness of a statewide trauma call center in reducing time to definitive care for severely injured patients

Porter

Wyrick

Bowman

et al. 2014

Journal of Trauma and Acute Care Surgery

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Should Age Be a Factor to Change From a Level II to a Level I Trauma Activation?

Abstract: Patients with an ISS between 0 and 15 are often triaged to Level II activation. Our data would suggest that patients older than 60 years should be a criterion for the highest level of trauma activation.

Cited by 50 publications

References 20 publications

Geriatric trauma service

Geriatric trauma service

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

The effectiveness of a statewide trauma call center in reducing time to definitive care for severely injured patients

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