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Development of Statewide Geriatric Patients Trauma Triage Criteria

Published online by Cambridge University Press:  04 August 2011

Howard A. Werman ,
Timothy Erskine ,
Jeffrey Caterino ,
Jane F. Riebe  and
Tricia Valasek
Howard A. Werman
Affiliation:
The Ohio State University, Columbus, Ohio USA
Timothy Erskine*
Affiliation:
Ohio Department of Public Safety, Columbus, Ohio USA
Jeffrey Caterino
Affiliation:
The Ohio State University, Columbus, Ohio USA
Jane F. Riebe
Affiliation:
Hospital Council of Northwest Ohio, Toledo, Ohio USA
Tricia Valasek
Affiliation:
National Association of Local Boards of Health, Bowling Green, Ohio USA
*
Correspondence: Timothy Erskine Ohio Department of Public SafetyEMS Division, 1970 West Broad StreetColumbus, OH 43223 USA E-mail: [email protected]
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Abstract

Introduction: The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims.

Methods: A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria.

Results: The following criteria were identified as geriatric-specific criteria: (1) GCS score <14 in the presence of known or suspected traumatic brain trauma; (2) SBP <100 mmHg; (3) fall from any height with evidence of traumatic brain injury: (4) multiple body-system injuries; (5) struck by a moving vehicle; and (6) the presence of any proximal long bone fracture following motor vehicle trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center.

Conclusions: The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the overall mortality in the elderly.

Keywords

emergency medical servicesgeriatricOhiotraumatrauma centertrauma registry
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 26 , Issue 3 , June 2011 , pp. 170 - 179
Copyright
Copyright Werman © World Association for Disaster and Emergency Medicine 2011

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References

US Census Bureau: Population Projections Program, Population Division, US Census Bureau, Washington, D.C. Available at http://www.census.gov. Accessed January 2008.Google Scholar
Clark, DE, Fantus, RE: National Trauma Data Bank 2007 Annual Report, version 7.0. Available at http://www.facs.org/trauma/ntdb/ntdbannualreport2007.pdf. Accessed January 2008.Google Scholar
US Centers for Disease Control and Prevention (CDC): Ten Leading Causes of Injury Death by Age Group Highlighting Unintentional Injury Deaths, 2003. National Vital Statistics System, National Center for Health Statistics, Centers for Disease Control.Google Scholar
Morris, JAJ, MacKenzie, EJ, Damiano, AM, Bass, SM: Mortality in trauma patients: the interaction between host factors and severity. J Trauma 1990;30:1476–1482.CrossRefGoogle Scholar
Gubler, KD, Davis, R, Koepsell, T, Soderberg, R, Maier, RV, Rivara, FP: Long-term survival of elderly trauma patients. Arch Surg 1997;132:1010–1014.CrossRefGoogle ScholarPubMed
Milzman, DP, Boulanger, BR, Rodriguez, A, Soderstrom, CA, Mitchell, KA, Magnant, CM: Pre-existing disease in trauma patients: A predictor of fate independent of age and injury severity score. J Trauma 1992;32:236–243.CrossRefGoogle ScholarPubMed
Fulton, M, Allen, E: Polypharmacy in the elderly: A literature review. J Am Acad Nurse Pract. 2005;17(4):123–132.CrossRefGoogle ScholarPubMed
Ballentine, NH: Polypharmacy in the elderly: Maximizing benefit, minimizing harm. Crit Care Nurs Quart 2008;31:40–45.CrossRefGoogle ScholarPubMed
Pieracci, FM, Eachempati, SR, Shou, J, Hydo, LJ, Barie, PS: Degree of anticoagulation, but not warfarin use itself, predicts adverse outcomes after traumatic brain injury in elderly trauma patients. J Trauma 2007;63(3):525–530.Google Scholar
Mina, AA, Knipfer, JF, Park, DY, Bair, HA, Howells, GA, Bendick, PJ: Intracranial complications of pre-injury anticoagulation in trauma patients with head injury. J Trauma 2002;53:668–672.CrossRefGoogle Scholar
Perdue, PW, Watts, DD, Kaufmann, CR, Trask, AL: Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death. J Trauma 1998;45:805–810.CrossRefGoogle ScholarPubMed
Smith, DP, Enderson, BL, Maull, KI: Trauma in the elderly: determinants of outcome. South.Med J 1990;83:171–177.CrossRefGoogle ScholarPubMed
Lonner, JH, Koval, KJ. Polytrauma in the elderly. Clin Orthop 1995;318:136–143.Google Scholar
Mueller, SM, Gibson, RM: Age difference in health care spending. Soc Secur Bull 1976;36:18.Google Scholar
CDC: Field Triage Decision Scheme available at http://www.cdc.gov/ncipc/dir/FLD_TRIAGE.doc. Accessed January 2008.Google Scholar
Phillips, S, Rond, PC 3rd, Kelly, SM, Swartz, PD: The failure of triage criteria to identify geriatric patients with trauma: Results from the Florida Trauma Triage Study. J Trauma 1996;40:278–283.CrossRefGoogle ScholarPubMed
Chang, DC, Bass, RR, Cornwell, EE, MacKenzie, EJ: Undertriage of elderly patients to state designated trauma centers. Arch Surg 2008;143:776–781.CrossRefGoogle ScholarPubMed
Ma, MH, MacKenzie, EJ, Alcorta, R, Kelen, GD: Compliance with prehospital triage protocols for major trauma patients. J Trauma 1999;46:168–175.Google ScholarPubMed
Champion, HR, Copes, WS, Buyer, D, Flanagan, ME, Bain, L, Sacco, WJ: Major trauma in geriatric patients. Am J Public Health 1989;79:1278–1282.CrossRefGoogle ScholarPubMed
Tornetta, P, Mostafavi, H, Riina, J, Turen, C, Reimer, , Levine, R, Behrens, F, Geller, J, Ritter, C, Homel, P: Morbidity and mortality in elderly trauma patients. J Trauma 1999;46:702–706.CrossRefGoogle ScholarPubMed
Sugimoto, K, Aruga, T, Hirata, M, Shindo, M: Geriatric trauma paitnets at a suburban Level-I trauma center in Japan. Prehosp Disaster Med 1999;14:186–190.CrossRefGoogle Scholar
Helling, TS, Watkins, M, Evans, LL, Nelson, PW, Shook, JW, Van Way, CW: Low falls: An underappreciated mechanism of injury. J Trauma 1999;46:453–456.CrossRefGoogle ScholarPubMed
McGwin, G, MacLennan, PA, Bailey, J, Davis, GG, Rue III, LW: Preexisting conditions and mortality in older trauma patients. J Trauma 2004;56:1291–1296.CrossRefGoogle ScholarPubMed
Zautchke, JL, Coker, JB Jr, Morris, RW, Stein-Spencer, L: Geriatric trauma in the state of Illinois: Substance use and injury patterns. Am J Emerg Med 2002;20:14–17.CrossRefGoogle Scholar
Richmond, TS, Kauder, D, Strumpf, N, Meredith, T: Characteristics and outcomes of serious traumatic injury in older adults. J Am Geriatr Soc 2002;50:215–222.CrossRefGoogle ScholarPubMed
Personal communication: David Schatz, MD, Florida EMS Advisory Council, January 2007.Google Scholar
Jacobs, DG, Plaisier, BR, Barie, PS, Hammond, JS, Holevar, MR, Sinclair, KE, Scalea, TM, Wahl, W, EAST Practice Management Guidelines Work Group: Practice management guidelines for geriatric trauma: The EAST Practice Management Guidelines Work Group. J Trauma 2003;54:391–416.CrossRefGoogle ScholarPubMed
Finelli, FC, Jonsson, J, Champion, HR, Morelli, S, Fouty, WJ: A case control study for major trauma in geriatric patients. J Trauma 1989;29:541–548.CrossRefGoogle ScholarPubMed
Caterino, JM, Valasek, T, Werman, H. Identification of an age cutoff for increased mortality in elderly trauma patients. Am J Emerg Med 2010;28:151–158.CrossRefGoogle Scholar
Victorino, GP, Chong, TJ, Pal, JD: Trauma in the elderly patient. Arch Surg 2003;138:1093–1098.CrossRefGoogle ScholarPubMed
Ohio Department of Public Safety, Division of Emergency Medical Services: Ohio Trauma Registry Dictionary 2004. Columbus: Ohio Department of Public Safety, 2004.Google Scholar
CDC. National Center for Health Statistics: The Barell Injury Diagnosis Matrix, Classification by Body Region and Nature of the Injury. Available at http://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdf. Accessed 24 June 2010.Google Scholar
Ohio Revised Code 4765.06 (B) Emergency medical services incidence reporting system—State trauma registry.Google Scholar
Demetriades, D, Sava, J, Alo, K, Newton, E, Velmahos, GC, Murray, JA, Belzberg, H, Asensio, JA, Berne, TV: Old age as a criterion for trauma team activitation. J Trauma 2001;51:754–757.CrossRefGoogle Scholar
Zimmer-Gembeck, MJ, Southard, PA, Hedges, RJ, Mullins, RJ, Rowland, D, Stone, JV, Trunkey, DD: Triage in an established trauma system. J Trauma 1995;39:922–928.CrossRefGoogle Scholar
Scheetz, L: Effectiveness of prehospital trauma triage guidelines for the identification of major trauma in elderly motor vehicle crash victims. J Emerg Nurs 2003;29:109–115.CrossRefGoogle ScholarPubMed
Huei-Ming, M, Mackenzie, E, Alcorta, R, Kelen, G: Compliance with prehospital triage protocols for major trauma patients. J Trauma 1999;46:168–175.Google Scholar
Baez, AA, Lane, PL, Sorondo, B: System compliance with out of hospital trauma triage criteria. J Trauma 2003;54:344–351.Google ScholarPubMed
National Diabetes Statistics, 2007 from the National Diabetes Information Clearinghouse. Bethesda, MD: US Department of Health and Human Resources, pp 1–24.Google Scholar
Rosamond, W, Flegal, K, Furie, K, Go, A, Greenlund, K, Haase, N, Hailpern, SM, Ho, M, Howard, V, Kissela, B, Kittner, S, Lloyd-Jones, D, McDermott, M, Meigs, J, Moy, C, Nichol, G, O'Donnell, C, Roger, V, Sorlie, P, Steinberger, J, Thom, T, Wilson, M, Hong, Y; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:e25–e146.Google ScholarPubMed
Cushman, JT, Patel, NB, Jones, CM, Swor, RA, Lerner, EB, Shah, MN: A comparison of the Ohio and American College of Surgeons Guidelines in identifying trauma center need for older adults (abstract). Prehosp Emerg Care 2009;13:117–118.Google Scholar
Mullins, RJ, Mann, C, Hedges, JR, Worrall, W, Helfand, M, Zechnich, AD, Jurkovich, GJ: Adequacy of hospital discharge status as a measure of outcome among injured patients. JAMA 1998;279:1727–1731.CrossRefGoogle ScholarPubMed