Undertriage in geriatric trauma: insights from a multicentre cohort study

With the aging population, the number of geriatric trauma patients continues to rise, posing significant challenges for emergency care and trauma management. Structured trauma team activation (TTA) protocols aim to provide timely and adequate treatment for severely injured patients. However, evidence suggests that current triage criteria may inadequately address the specific needs of geriatric patients, potentially leading to undertriage and worse outcomes.

The prospective, multicentre observational cohort study analysed trauma team activation and triage practices for patients aged ≥ 70 years across 12 Level 1 trauma centres across rural and urban regions in Germany and Switzerland. Data were prospectively collected from December 2020 to February 2021, following the STROBE guidelines. Triage decisions were compared with the TAcTIC (Trauma Team Activation and Trauma/Injury Care) consensus criteria to assess undertriage and overtriage rates. Key outcomes included trauma team activation rates, injury severity, transport characteristics, and early mortality.

Among 3,753 trauma patients, 1,371 (36.5%) were geriatric (≥ 70 years). Trauma team activation was significantly lower in the geriatric group (15.8%) compared to younger patients (31.8%), despite similar injury severity. Post-hoc analysis revealed that 53.8% of geriatric patients requiring trauma care were undertriaged. Head injuries (47.7%) and pelvic fractures (5.7%) were more common in geriatric patients in comparison to the younger cohort. Mortality within 48 h was more than three times as high in geriatric patients (1.8% vs. 0.5%).

A significant undertriage rate (53.8%) was identified among geriatric trauma patients, contributing to delayed care and increased mortality. Undertriage of geriatric trauma patients remains a critical issue, reflecting the insufficiency of current trauma activation protocols. Tailored triage criteria that even more consider age-related physiological differences, comorbidities, and frailty are urgently needed. Future updates to trauma guidelines should aim to reduce undertriage and improve outcomes for this vulnerable population.

Not applicable.