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Age-related differences in prehospital triage and critical interventions: a multicenter TraumaRegister DGU® analysis
Daniel Anthony Koch1, Paul Hagebusch2, Lisa Hackenberg3
1Department of Trauma Surgery and Orthopaedics, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt, Germany. D.anthony.koch@gmail.com.
Insights
Older trauma patients receive less advanced prehospital interventions, especially in high-risk scenarios, despite similar injury severity. This highlights a need to refine triage and treatment guidelines for an aging trauma population.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Geriatric Care
Background:
- Older adults are often undertriaged in prehospital settings.
- Disparities in prehospital interventions for older trauma patients are not well understood.
Purpose of the Study:
- To evaluate age-related differences in prehospital triage, allocation, and treatment.
- To analyze age-based variations in critical interventions within a physician-staffed EMS system.
Main Methods:
- Retrospective analysis of 67,069 trauma patients (≥20 years) from 2020-2023.
- Stratification into age groups (20-59 vs. ≥60 years).
- Analysis of prehospital interventions, transport, and trauma center allocation, including high-risk scenarios.
Main Results:
- Older patients were less likely to receive air transport or be allocated to supra-regional trauma centers.
- Despite comparable injury severity, older patients received less endotracheal intubation and tranexamic acid.
- Overall intervention rates were similar, but differences emerged in high-risk situations.
Conclusions:
- Age-related differences in prehospital triage and allocation correlate with selective treatment variations.
- Prehospital care for older trauma patients appears individualized, not uniformly reduced.
- Refinement of triage algorithms and guidelines is needed for the aging trauma population.
Purpose:
Older trauma patients are known to be undertriaged in the prehospital setting. However, it remains unclear whether these disparities translate into differences in the delivery of critical prehospital interventions. This study aimed to evaluate age-related differences in prehospital triage, allocation, and treatment within a physician-staffed emergency medical service system.
Methods:
A retrospective multicenter analysis of the TraumaRegister DGU® was conducted, including trauma patients aged ≥ 20 years between 2020 and 2023 with trauma team activation and subsequent intensive care unit admission. Patients were stratified into two age groups, 20-59 vs. ≥60 years, with additional subgroups up to 90-99 years. Prehospital interventions, transport modality, and trauma center allocation were analyzed. Furthermore, predefined high-risk scenarios (severe motor vehicle trauma, traumatic brain injury with GCS ≤ 8, and pneumothorax) were evaluated.
Results:
A total of 67,069 patients were included, with comparable injury severity across age groups (mean ISS 20.2). Older patients were less frequently transported by air and less often allocated to supra-regional trauma centers. While overall intervention rates were similar, differences emerged in high-risk scenarios. Older patients received endotracheal intubation and tranexamic acid less frequently despite comparable injury severity. Prehospital chest tube placement rates were low and similar across age groups.
Conclusion:
Age-related differences in prehospital triage and allocation are associated with selective differences in treatment, particularly in high-risk situations. These findings suggest that prehospital care in older trauma patients is individualized rather than uniformly reduced, but highlight the need to refine triage algorithms and guideline implementation in an aging trauma population.
