Towards improving prehospital triage for older trauma patients

Alshibani, Abdullah; Singler, B.; Conroy, Simon

doi:10.1007/s00391-021-01844-4

Cited by 13 publications

(13 citation statements)

References 43 publications

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“…Older trauma patients usually have injuries compounded with multimorbidity and frailty. This could adversely affect the accuracy of prehospital trauma triage tools even when geriatric-specific triage criteria were developed to adjust for age-related anatomical and physiological changes, comorbidities, and medication use [61], as shown in this review. Therefore, integrating other assessment tools, such as frailty, into the trauma triage tool may improve the identification of high-risk patients and reduce under-triage [62].…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

2021

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“…Some of which could directly affect meeting the thresholds of the existing triage criteria for direct transportation to an MTC including anatomical and physiological changes with age, comorbidities, and medication use. 71 The efforts in recent research tried to overcome these challenges by developing geriatric-specific trauma triage criteria that are accurate enough to capture severely injured older patients. 71 However, no geriatric-specific trauma triage criteria have achieved acceptable sensitivity and/or specificity 71 and some were not applied to all older trauma patients.…”

Section: Factors Affecting Appropriate Triage Decisionsmentioning

confidence: 99%

“…71 The efforts in recent research tried to overcome these challenges by developing geriatric-specific trauma triage criteria that are accurate enough to capture severely injured older patients. 71 However, no geriatric-specific trauma triage criteria have achieved acceptable sensitivity and/or specificity 71 and some were not applied to all older trauma patients. 8 Despite these factors, there are other important factors that are not related to triage criteria and could significantly affect prehospital trauma triage decisions for older patients.…”

Section: Factors Affecting Appropriate Triage Decisionsmentioning

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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“…Die United European Medical Societies -Geriatric Medicine Section (UEMS-GMS) definierte geriatrische Patienten als Patienten mit typischer geriatrischer Multimorbidität und höherem Alter (> 70) oder Patienten ab 80 Jahren "aufgrund der alterstypisch erhöhten Vulnerabilität" durch diverse Vorerkrankungen [5]. Somit sollte nicht das kalendarische Alter allein, sondern das Zusammenspiel des physiologischen Prozesses des Alterns mit Komorbiditäten, Medikamentengebrauch und Verlust der Selbstständigkeit für die Definition eines geriatrischen Patienten ausschlaggebend sein [6].…”

Section: Definition Und Besonderheiten Des Geriatrischen Patientenunclassified