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The found down patient: A Western Trauma Association multicenter study.

Benjamin M Howard1, Lucy Z Kornblith, Amanda S Conroy

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The Journal of Trauma and Acute Care Surgery
|October 22, 2015
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Patients found unconscious ("found down") face significant mistriage. Advanced age and combined medical issues predict misdiagnosis, highlighting the need for improved triage protocols to prevent missed injuries in this vulnerable group.

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Area of Science:

  • Emergency Medicine
  • Trauma Surgery
  • Clinical Triage

Background:

  • Unconscious patients found down present unique triage challenges.
  • Previous studies indicate significant occult injuries and missed diagnoses in this population.
  • A multicenter study aimed to characterize this patient group and identify mistriage predictors.

Purpose of the Study:

  • To further characterize patients presenting as "found down" across multiple trauma centers.
  • To identify predictors of mistriage in this vulnerable patient population.
  • To improve resource allocation and minimize missed injuries.

Main Methods:

  • Retrospective analysis of 661 patients categorized as "found down" at seven major trauma centers.
  • Data collected included demographics, clinical information, and outcomes.
  • Logistic regression was used to identify predictors of mistriage, defined as admission to a non-triage-activated service.

Main Results:

  • 56% of patients had traumatic injuries, yet only 33% were triaged to trauma evaluation.
  • 17% of admitted patients were mistriaged, and 23% of properly triaged patients required cross-consultation.
  • Advanced age (over 70) and combined medical diagnosis/injury were independent predictors of mistriage.

Conclusions:

  • Patients found down experience high rates of mistriage and triage discordance.
  • Despite most being triaged to non-trauma services, over half have traumatic injuries.
  • Identifying mistriage predictors like advanced age can optimize resource use and reduce missed injuries.