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.
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.
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.
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%.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Resources for the Optimal Care of the Injured Patient.6th ed. American College of Surgeons, Chicago, IL2014
- Old age as a criterion for trauma team activation.J Trauma. 2001; 51: 754-756
- Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma.J Trauma Acute Care Surg. 2015; 78: 352-359
- Delayed trauma team activation.J Trauma Acute Care Surg. 2012; 73: 695-698
- The impact of advanced age on trauma triage decisions and outcomes: a statewide analysis.Am J Surg. 2009; 197: 571-575
- Geriatric falls: injury severity is high and disproportionate to mechanism.J Trauma. 2001; 50: 116-119
- Effect on outcome of early intensive management of geriatric trauma patients.Br J Surg. 2002; 89: 1319-1322
- Geriatric trauma patients—are they receiving trauma center care?.Acad Emerg Med. 2003; 10: 244-250
- Factors associated with trauma center use for elderly patients with trauma.Arch Surg. 2011; 146: 585
- Trauma in the elderly: intensive care unit resource use and outcome.J Trauma. 2002; 53: 407-414
- Old and undertriaged: a lethal combination.Am Surg. 2012; 78: 711-715
- Defining geriatric trauma: when does age make a difference?.Surgery. 2012; 152: 668-675
Published online: May 08, 2019
Accepted: April 1, 2019
Received in revised form: April 1, 2019
Received: January 26, 2019
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.
© 2019 Elsevier Inc. All rights reserved.