Undertriage in geriatric trauma: insights from a multicentre cohort study

Area of Science:

• Geriatric Trauma Care
• Emergency Medicine
• Trauma Surgery

Background:

• The aging global population presents increasing challenges in geriatric trauma management.
• Current trauma team activation (TTA) protocols may not adequately identify severely injured elderly patients, leading to undertriage.
• This can result in delayed treatment and poorer outcomes for geriatric trauma patients.

Purpose of the Study:

• To evaluate trauma team activation and triage practices for geriatric patients (≥70 years).
• To assess undertriage and overtriage rates in elderly trauma patients using established criteria.
• To identify the impact of current triage protocols on outcomes in this vulnerable population.

Main Methods:

• A prospective, multicentre observational cohort study was conducted across 12 Level 1 trauma centres in Germany and Switzerland.
• Data from 3,753 trauma patients, including 1,371 geriatric patients, were collected from December 2020 to February 2021.
• Triage decisions were compared against the TAcTIC consensus criteria to determine undertriage and overtriage rates.

Main Results:

• Geriatric patients had significantly lower trauma team activation rates (15.8%) compared to younger patients (31.8%), despite similar injury severity.
• A substantial undertriage rate of 53.8% was observed in geriatric patients requiring trauma care.
• Geriatric patients experienced higher mortality within 48 hours (1.8% vs. 0.5%) and more frequent head injuries and pelvic fractures.

Conclusions:

• A high rate of undertriage among geriatric trauma patients indicates a critical deficiency in current trauma activation protocols.
• Existing triage criteria are insufficient for accurately identifying the needs of elderly patients, contributing to delayed care and increased mortality.
• Revised, age-specific triage criteria are urgently needed to improve outcomes for geriatric trauma patients.