The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan

Meyers, Matthew H.; Wei, Trent; Cyr, Julianne; Hunold, Thomas; Shofer, Frances S.; Cowden, Christopher S.; Moss, Chailee; Jensen, Christopher E.; Platts‐Mills, Timothy F.; Brice, Jane H.

doi:10.1017/s1049023x19004825

Cited by 7 publications

(12 citation statements)

References 26 publications

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“…Most of the included studies were conducted in the USA (n = 21) [36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. Eleven studies were published in the last five years [41, 43-45, 47, 50, 52, 55-58], four of which were published in 2020 [41,[55][56][57].…”

Section: Resultsmentioning

confidence: 99%

“…In addition, 15% were transported by Helicopter Emergency Medical Services (HEMS) compared to 20% of younger trauma patients [47]. Indeed, Meyers et al [50] showed that almost 3% of the entire study population of older trauma patients were transported through HEMS although 31% of them met the trauma triage criterion (≥ 60 min from the nearest TC). Some older trauma patients were not triaged in prehospital care, which may explain the issue of increased undertriage rates in this population.…”

Section: Under-triage Ratesmentioning

confidence: 99%

“…For injured patients meeting current triage criteria, there was a constant decrease in the rate of destination compliance with increasing age [37,50,51]. Trauma patients aged > 60 years had a greater under-triage rate when defined by hospital destination; indicating that older trauma patients meeting the triage criteria were not as likely to be transported to TCs [51].…”

Section: Destination Compliance and Current Triage Criteriamentioning

confidence: 99%

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

2021

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Under-triage Ratesmentioning

confidence: 99%

Section: Destination Compliance and Current Triage Criteriamentioning

confidence: 99%

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

2021

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“…The literature from the United States of America (USA) and Australia show increased rates of under-triage among this population. [3][4][5][6][7][8][9][10][11][12][13][14][15] Under-triage is simply defined as the transportation of severely injured patients to lower-level Trauma Centers (TCs) or other Acute Care (AC) facilitates, as opposed to Major Trauma Centers (MTCs) (equivalent to major trauma service or Level I or II TCs). 16 A number of recent studies in the USA developed trauma triage tools specific for older adults in order to improve early identification and appropriate triage and transportation decisions.…”

Section: Scope Of the Problemmentioning

confidence: 99%

“…The impact of prehospital triage decisions on outcomes of older trauma patients is still uncertain. 3,5,10,15 accuracy in identifying major trauma among older people 4,6,8,9,11,12,14,17,62 and only few were assessed for their effects on the outcomes, with mortality used as the main outcome measure. 3,5,7,10,13,15,63,64 Other outcomes including disability, complications, costs, LOS, and discharge to home were rarely captured in the assessment of triage tools.…”

Section: Prehospital Triage and Outcomesmentioning

confidence: 99%

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Alshibani¹,

Banerjee²,

Lecky³

et al. 2021

OAEM

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Caring for older people is an important part of prehospital practice, including appropriate triage and transportation decisions. However, prehospital triage criteria are designed to predominantly assess injury severity or high-energy mechanism which is not the case for older people who often have injuries compounded by multimorbidity and frailty. This has led to high rates of under-triage in this population. This narrative review aimed to assess aspects other than triage criteria to better understand and improve prehospital triage decisions for older trauma patients. This includes integrating frailty assessment in prehospital trauma triage, which was shown to predict adverse outcomes for older trauma patients. Furthermore, determining appropriate outcome measures and the benefits of Major Trauma Centers (MTCs) for older trauma patients should be considered in order to direct accurate and more beneficial prehospital trauma triage decisions. It is still not clear what are the appropriate outcome measures that should be applied when caring for older trauma patients. There is also no strong consensus about the benefits of MTC access for older trauma patients with regards to survival, in-hospital length of stay, discharge disposition, and complications. Moreover, looking into factors other than triage criteria such as distance to MTCs, patient or relative choice, training, unfamiliarity with protocols, and possible ageism, which were shown to impact prehospital triage decisions but their impact on outcomes has not been investigated yet, should be more actively assessed and investigated for this population. Therefore, this paper aimed to discuss the available evidence around frailty assessment in prehospital care, appropriate outcome measures for older trauma patients, the benefits of MTC access for older patients, and factors other than triage criteria that could adversely impact accurate prehospital triage decisions for older trauma patients. It also provided several suggestions for the future.

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Towards improving prehospital triage for older trauma patients

2021

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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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The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan

Cited by 7 publications

References 26 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

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Towards improving prehospital triage for older trauma patients

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