Geriatric Trauma Activation

The American College of Surgeons indicated geriatric-specific trauma team activation criteria to minimize undertriage. We evaluated activation volumes and outcomes for older adults before and after implementation of revised criteria.

Data were collected from institutional trauma registry and nonregistry data repository for patients ≥65 y presenting directly to a level I trauma center with blunt trauma, preguideline, and post guideline revision. The repository encompasses activation patients with no injuries or minor injuries who are discharged home from the ED or admitted for noninjury related reasons. Trauma team activation rates, resource utilization, and outcomes were examined.

After revision, trauma registry (prerevision: 295 versus post revision: 915 patients) and nonregistry (prerevision: 132 versus post revision: 1703 patients) activations markedly increased. The most common activation criterion post revision was elderly fall on antithrombotic (prerevision: 34.9% versus post revision: 69.6%). Activated registry patients had significantly lower median Injury Severity Scores (prerevision: 10 versus post revision: 5) and mortality rates (prerevision: 8.1% versus post revision: 4.3%), with higher emergency department to home discharge rates (prerevision: 10.2% versus post revision: 28.9%) post guideline revision. Activations were associated with prerevision: 4.5-fold and post revision: 4.0-fold faster time to index computed tomography scan completion than nonactivations.

Activations markedly increased post guideline revision with many patients having no injuries or minor injuries that did not meet registry inclusion criteria. The increased activations were largely associated with elderly falls on antithrombotics. Among those meeting criteria, the Injury Severity Score was low, and they were more frequently discharged home from the ED. An opportunity for optimizing resource utilization may exist.