Old Age With a Traumatic Mechanism of Injury Should Be a Trauma Team Activation Criterion.
Age Factors
Aged
Aged, 80 and over
Emergency Service, Hospital
/ organization & administration
Female
Geriatrics
/ methods
Humans
Injury Severity Score
Male
Registries
/ statistics & numerical data
Retrospective Studies
Trauma Centers
/ organization & administration
Triage
/ methods
Wounds and Injuries
/ complications
geriatric
overtriage
trauma team activation
Journal
The Journal of emergency medicine
ISSN: 0736-4679
Titre abrégé: J Emerg Med
Pays: United States
ID NLM: 8412174
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
26
01
2019
revised:
01
04
2019
accepted:
01
04
2019
pubmed:
13
5
2019
medline:
17
6
2020
entrez:
13
5
2019
Statut:
ppublish
Résumé
Age is not a standard trauma team activation (TTA) criteria recommended by the Committee on Trauma. However, there is concern that vital signs in elderly patients are often unreliable. In addition, elderly patients are at risk after moderate trauma. At our institution, age ≥ 70 years with traumatic mechanisms of injury has been a TTA criterion for more than 15 years. Our aim was to determine whether age ≥70 years as a TTA criterion appropriately identifies patients in need of additional resources without significantly impacting overtriage rates. We conducted a retrospective trauma registry study of TTAs for age ≥ 70 years from January 2012-December 2016. Demographics, injury data, Injury Severity Score (ISS), procedures, emergency department (ED) disposition, and hospital data were collected. Primary outcome was mortality, secondary outcomes were intensive care unit (ICU) and hospital lengths of stay. Patients were stratified into meeting standard criteria (TTA-S) or activated based on age alone (TTA-A). TTA patients with ISS > 15, ED intubation, ICU admission, immediate operating room or catheter-based intervention, and mortalities were appropriately triaged. During the study, there were 5436 total TTAs. Seven hundred and thirty-nine TTAs in patients aged ≥ 70 years, of which 198 (26.8%) were TTA-S and 541 (73.2%) were TTA-A. In the TTA-A group, 49 (9%) patients died, 149 (27.5%) had ISS > 15, 65 (12%) underwent immediate intervention, 72 (13%) had ED intubations, and 306 (56.6%) required admission to the ICU. The overtriage rate in the TTA-A group was 39.6%. Elderly patients with severe trauma patients often do not meet the standard TTA criteria, resulting in potentially dangerous undertriage. Addition of age (≥70 years) criterion for TTA reduces undertriage and does not result in excessive overtriage.
Sections du résumé
BACKGROUND
BACKGROUND
Age is not a standard trauma team activation (TTA) criteria recommended by the Committee on Trauma. However, there is concern that vital signs in elderly patients are often unreliable. In addition, elderly patients are at risk after moderate trauma. At our institution, age ≥ 70 years with traumatic mechanisms of injury has been a TTA criterion for more than 15 years.
OBJECTIVE
OBJECTIVE
Our aim was to determine whether age ≥70 years as a TTA criterion appropriately identifies patients in need of additional resources without significantly impacting overtriage rates.
METHODS
METHODS
We conducted a retrospective trauma registry study of TTAs for age ≥ 70 years from January 2012-December 2016. Demographics, injury data, Injury Severity Score (ISS), procedures, emergency department (ED) disposition, and hospital data were collected. Primary outcome was mortality, secondary outcomes were intensive care unit (ICU) and hospital lengths of stay. Patients were stratified into meeting standard criteria (TTA-S) or activated based on age alone (TTA-A). TTA patients with ISS > 15, ED intubation, ICU admission, immediate operating room or catheter-based intervention, and mortalities were appropriately triaged.
RESULTS
RESULTS
During the study, there were 5436 total TTAs. Seven hundred and thirty-nine TTAs in patients aged ≥ 70 years, of which 198 (26.8%) were TTA-S and 541 (73.2%) were TTA-A. In the TTA-A group, 49 (9%) patients died, 149 (27.5%) had ISS > 15, 65 (12%) underwent immediate intervention, 72 (13%) had ED intubations, and 306 (56.6%) required admission to the ICU. The overtriage rate in the TTA-A group was 39.6%.
CONCLUSIONS
CONCLUSIONS
Elderly patients with severe trauma patients often do not meet the standard TTA criteria, resulting in potentially dangerous undertriage. Addition of age (≥70 years) criterion for TTA reduces undertriage and does not result in excessive overtriage.
Identifiants
pubmed: 31078345
pii: S0736-4679(19)30263-X
doi: 10.1016/j.jemermed.2019.04.003
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
151-155Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.