Abstract
Background
Age is not a standard trauma team activation (TTA) criteria recommended by the Committee
on Trauma. However, there is concern that vital signs in elderly patients are often
unreliable. In addition, elderly patients are at risk after moderate trauma. At our
institution, age ≥ 70 years with traumatic mechanisms of injury has been a TTA criterion
for more than 15 years.
Objective
Our aim was to determine whether age ≥70 years as a TTA criterion appropriately identifies
patients in need of additional resources without significantly impacting overtriage
rates.
Methods
We conducted a retrospective trauma registry study of TTAs for age ≥ 70 years from
January 2012–December 2016. Demographics, injury data, Injury Severity Score (ISS),
procedures, emergency department (ED) disposition, and hospital data were collected.
Primary outcome was mortality, secondary outcomes were intensive care unit (ICU) and
hospital lengths of stay. Patients were stratified into meeting standard criteria
(TTA-S) or activated based on age alone (TTA-A). TTA patients with ISS > 15, ED intubation,
ICU admission, immediate operating room or catheter-based intervention, and mortalities
were appropriately triaged.
Results
During the study, there were 5436 total TTAs. Seven hundred and thirty-nine TTAs in
patients aged ≥ 70 years, of which 198 (26.8%) were TTA-S and 541 (73.2%) were TTA-A.
In the TTA-A group, 49 (9%) patients died, 149 (27.5%) had ISS > 15, 65 (12%) underwent
immediate intervention, 72 (13%) had ED intubations, and 306 (56.6%) required admission
to the ICU. The overtriage rate in the TTA-A group was 39.6%.
Conclusions
Elderly patients with severe trauma patients often do not meet the standard TTA criteria,
resulting in potentially dangerous undertriage. Addition of age (≥70 years) criterion
for TTA reduces undertriage and does not result in excessive overtriage.
Keywords
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Article info
Publication history
Published online: May 08, 2019
Accepted:
April 1,
2019
Received in revised form:
April 1,
2019
Received:
January 26,
2019
Footnotes
The data in this manuscript are the original work of the authors and were presented as a poster at the 77th Annual Meeting of the American Association for the Surgery of Trauma, September 26, 2018, San Diego, CA.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
