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Undertriage of Severe Geriatric Trauma Patients: Who Are We Missing?
Jiye Park1, Yo Huh2, Seoyoung Song3
1Department of Emergency Medicine, Seoul Red Cross Hospital, Seoul, Korea.
Insights
Older women with ground fall injuries and cerebrovascular disease are undertriaged in trauma care. Developing geriatric-specific triage guidelines is crucial for improving outcomes in this vulnerable population.
Area of Science:
- Trauma Surgery
- Geriatric Medicine
- Public Health
Background:
- Geriatric trauma patients present unique challenges in prehospital triage.
- Existing triage protocols may not adequately identify high-risk older adults.
- Undertriage can lead to delayed definitive care and poorer outcomes.
Purpose of the Study:
- To identify risk factors associated with undertriage in geriatric trauma patients.
- To inform the development of improved prehospital triage strategies for older adults.
- To enhance collaboration between trauma surgeons and public health stakeholders.
Main Methods:
- Retrospective review of a Level-1 trauma center database (2016-2020).
- Inclusion criteria: patients aged ≥65 years with Injury Severity Score (ISS) >15.
- Comparison of pre-hospital and hospital factors between correctly triaged and undertriaged patients using TRISS, O:E ratio, z-score, and w-score.
Main Results:
- 22% of geriatric trauma patients (111/512) were undertriaged.
- Undertriaged patients were older, predominantly female, and had lower ISS and more head/neck injuries.
- Independent predictors of undertriage included female sex, ground fall injury, low prehospital systolic blood pressure, and cerebrovascular disease.
Conclusions:
- Geriatric trauma patients are undertriaged if they are female, sustain ground-level falls, are more alert, or have cerebrovascular disease.
- Geriatric-specific triage guidelines are needed.
- Collaboration between trauma surgeons and emergency medical services is essential to prevent undertriage.
Purpose:
Geriatric trauma patients have unique risk factors for being undertriaged, which differ from those in young trauma patients. This study aimed to identify these risk factors and their implications for public health stakeholders and trauma surgeons to improve prehospital triage of geriatric trauma patients.
Materials And Methods:
Data were retrospectively reviewed from single level-1 trauma center database in patients aged ≥65 years, with Injury Severity Score (ISS) >15 between 2016 and 2020. Pre-hospital and hospital factors were compared between correctly triaged and undertriaged patients. The probabilities of survival and outcomes for correct and undertriage were calculated using the Trauma and Injury Severity Score (TRISS), observed (O):expected (E) ratio, z-score, and w-score.
Results:
A total of 512 patients were included in the study; 401 (78%) were correctly triaged and 111 (22%) were undertriaged. Correct triage group presented significant z-score (correct triage: 4.29 vs. undertriage: -0.11), w-score (correct triage: 7.79 vs. undertriage: 4.29), and O:E ratio of mortality (correct triage: 0.73 vs. undertriage: 1.66). Undertriaged patients were older (77 [72-82] vs. 73 [68-80], p<0.001), had a higher women proportion (53% vs. 34%, p<0.001), had lower ISS (25 [17-25] vs. 27 [19-38], p<0.001), and had more head and neck injuries (89% vs. 65%, p<0.001). On multivariable logistic regression, female sex (odds ratio 2.55, 95% confidence interval [1.07-6.09], p=0.034), ground fall injury (5.82 [1.89-17.91], p=0.002), prehospital systolic blood pressure <110 mm Hg (0.13 [0.03-0.67], p=0.003), and presence of cerebrovascular disease (5.53 [1.35-22.68], p=0.018) were significantly associated with undertriage.
Conclusion:
Geriatric trauma patients were undertriaged when they were women, sustained ground-level fall injuries, the more alert in the scene, and had cerebrovascular disease. Trauma surgeons and fire agency stakeholders should collaborate to create geriatric-specific triage guidelines and educate paramedics about these risk factors to prevent undertriage in this patient population.
