Geriatric patients on antithrombotic therapy as a criterion for trauma team activation leads to over triage

Area of Science:

• Trauma surgery
• Geriatric emergency medicine
• Public health policy

Background:

• Institutions amended trauma activation criteria for geriatric patients (≥65 years) on antithrombotic medication with suspected head trauma.
• A Level II trauma activation was mandated for this specific high-risk demographic.

Purpose of the Study:

• To evaluate the impact of revised trauma activation criteria on patient management and outcomes.
• To assess changes in overtriage and undertriage rates following the policy change.

Main Methods:

• A retrospective review of the institutional trauma registry was conducted.
• Geriatric patients on antithrombotic medication presenting with head trauma were analyzed before and after the criteria amendment.
• Demographics, presentation, activation level, and outcomes were compared between the two groups.

Main Results:

• Trauma activation rates significantly increased post-policy change (19.9% vs. 74.9%).
• Overtriage, indicated by direct discharge home without injury, also increased (4.3% vs. 44%).
• Undertriage decreased, with fewer patients experiencing critical outcomes or traumatic intracranial hemorrhage without activation (65.1% vs. 23.5% and 70.7% vs. 27.3%, respectively).
• Mortality rates remained unchanged (4.3% vs. 2.0%).

Conclusions:

• The revised trauma activation criteria effectively reduced undertriage in high-risk geriatric patients.
• The policy led to increased overtriage but had minimal impact on overall mortality.
• These findings highlight the trade-offs between overtriage and undertriage when modifying trauma activation protocols.