1. Undertriage Despite Use of Geriatric-Specific Trauma Team Activation Guidelines : Who Are We Missing?
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Anantha, Ram V., Painter, Matthew D., Diaz-Garelli, Franck, Nunn, Andrew M., Miller III, Preston R., Chang, Michael C., Hoth, J. Jason, Miller, Preston R 3rd, and Jason Hoth, J
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OLDER patients , *SYSTOLIC blood pressure , *LOGISTIC regression analysis , *HOSPITAL mortality , *TRAUMATOLOGY diagnosis , *WOUND care , *MEDICAL triage , *SPECIALTY hospitals , *MEDICAL care for older people , *RETROSPECTIVE studies , *MEDICAL protocols , *TRAUMA severity indices , *HEALTH care teams , *KAPLAN-Meier estimator , *WOUNDS & injuries - Abstract
Background: Elderly trauma patients are at risk for undertriage, resulting in substantial morbidity and mortality. The objective of this study was to determine whether implementation of geriatric-specific trauma team activation (TTA) protocols appropriately identified severely-injured elderly patients.Methods: This single-center retrospective study evaluated all severely injured (injury severity score [ISS] >15), geriatric (≥65 years) patients admitted to our Level 1 tertiary-care hospital between January 2014 and September 2017. Undertriage was defined as the lack of TTA despite presence of severe injuries. The primary outcome was all-cause in-hospital mortality; secondary outcomes were mortality within 48 hours of admission and urgent hemorrhage control. A multivariable logistic regression analysis was performed to identify predictors of appropriate triage in this study.Results: Out of 1039 severely injured geriatric patients, 628 (61%) did not undergo TTA. Undertriaged patients were significantly older and had more comorbidities. In-hospital mortality was 5% and 31% in the undertriaged and appropriately triaged groups, respectively (P < .0001). One percent of undertriaged patients needed urgent hemorrhage control, compared to 6% of the appropriately triaged group (P < .0001). One percent of undertriaged patients died within 48 hours compared to 19% in the appropriately triaged group (P < .0001). Predictors of appropriate triage include GCS, heart rate, systolic blood pressure, lactic acid, ISS, shock, and absence of dementia, stroke, or alcoholism.Discussion: Geriatric-specific TTA guidelines continue to undertriage elderly trauma patients when using ISS as a metric to measure undertriage. However, undertriaged patients have much lower morbidity and mortality, suggesting the geriatric-specific TTA guidelines identify those patients at highest risk for poor outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2021
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