Comparison of type and severity of major injuries among undertriaged and correctly triaged older patients

Despite the use of prehospital triage algorithms and other trauma scoring methods, a substantial proportion of older patients with life-threatening injuries are undertriaged, increasing the risk of preventable death and disability.

The primary objective of this study was to describe the injury types, injury severity, and short-term survival outcomes of undertriaged older adults injured in motor vehicle collisions, compared to a group of correctly triaged older adults.

This secondary analysis of records extracted from the National Automotive Sampling System Crashworthiness Data System for the years 2004 through 2008 compared persons aged 65 years and older who sustained maximum Abbreviated Injury Scale (mAIS) 3, 4, and 5 injuries and were transported to non-trauma center hospitals to those with mAIS 3, 4, and 5 injuries who were transported to trauma center hospitals.

Records of 66,445 patients were analyzed. Females comprised 61.8% (n=41,085) of the total sample. There were 6846 fatalities (10.3%) within 30 days of the crash, with 5708 (83.3%) of these attributed to injuries. Most patients sustained multiple injuries. Among the 17,403 undertriaged patients, brain injuries were the most common injury (n=5401, 31.1%), followed by thoracic fractures (n=5167, 29.7%), lower extremity fractures (n=4405, 25.3%), cervical spine fractures (n=3720, 21.4%), and thoracic-lumbar spine fractures (n=3513, 20.2%). Undertriaged patients also sustained an additional 2232 chest injuries, including contusions, vascular lacerations, diaphragm rupture, and unspecified injuries across all three AIS groups. The most common AIS 4 and 5 injuries were thoracic fractures.

The large number of undertriaged patients with AIS 3, 4, and 5 injuries underscores the need for a thorough search for life-threatening injuries among older adults who present to non-trauma center Emergency Departments after motor vehicle collisions.