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

Area of Science:

• Emergency Medicine
• Geriatric Trauma Care
• Prehospital Care Systems

Background:

• Older trauma patients are often under-triaged in prehospital settings, raising concerns about adverse outcomes.
• Existing trauma triage criteria demonstrate poor sensitivity in identifying major trauma in elderly individuals.
• The impact of prehospital triage decisions on outcomes for older trauma patients requires further investigation.

Purpose of the Study:

• To systematically review prehospital under-triage rates for older trauma patients.
• To assess the accuracy of current trauma triage criteria for this population.
• To evaluate the impact of prehospital triage decisions on the outcomes of older trauma patients.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE, Scopus, and CINHAL databases (1966-2021).
• Studies meeting inclusion criteria were critically appraised using the Critical Appraisal Skills Programme tool.
• Narrative synthesis was employed due to the heterogeneity of the included studies.

Main Results:

• Current trauma triage guidelines exhibit low sensitivity for identifying major trauma and the need for trauma center (TC) care in older adults.
• Modified triage tools show improved sensitivity but often have decreased specificity or limited application.
• The reasons for low TC transport rates among positively triaged older patients are unclear, and TC treatment benefits remain uncertain.

Conclusions:

• Under-triage of older trauma patients in prehospital care is a persistent issue with uncertain outcome implications.
• Further high-quality prospective research is essential to refine prehospital triage accuracy for older adults.
• Investigating factors influencing transport decisions and the precise impact of under-triage on outcomes is crucial.