The Dilemma of Prehospital Trauma Triage in Geriatric Anticoagulated Patients Sustaining Falls: Are Objective Clinical Factors Actually Helpful?

Ground-level fall is a common mechanism of injury among geriatric patients taking anticoagulants. Predicting significant injury in these low mechanism injuries can be challenging. Our study investigates whether early clinical variables available to prehospital providers actually aid in this triage process. We retrospectively reviewed anticoagulated patients aged ≥65 years who sustained a ground-level fall and categorized them into two groups: (1) those requiring admission for traumatic injury and (2) those not requiring admission for traumatic injury. We compared basic clinical factors readily available for prehospital triage to assess their utility in predicting significant injury. We found that commonly available prehospital clinical variables did not identify which patients sustained significant injury. Among 699 patients, 486 (69.2%) required trauma admission and 213 (30.3%) did not. Comparing patients requiring trauma admission to those not requiring admission, no difference in systolic blood pressure (146.7 vs 142.0, P = 0.07), heart rate (82.8 vs 83.0, P = 0.94), Glasgow Coma Scale (GCS) (14.2 vs 14.5, P = 0.10), or fall mechanism was identified. In a subset analysis comparing patients with ISS <9 to ISS >9, GCS was the only parameter to meet statistical significance (14.5 vs 14.1, P=0.03) but not clinical significance. Our data suggests that readily available clinical markers are insufficient for triage decisions in the setting of geriatric patients on anticoagulants sustaining a fall. Until such factors are clearly identified, maintaining a low threshold for triaging these patients to a higher level of care is essential to minimize the risk of under-triage in this vulnerable patient population.