Undertriage Despite Use of Geriatric-Specific Trauma Team Activation Guidelines : Who Are We Missing?
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 (
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.
Published In/Presented At
Anantha, R. V., Painter, M. D., Diaz-Garelli, F., Nunn, A. M., Miller, P. R., 3rd, Chang, M. C., & Jason Hoth, J. (2021). Undertriage Despite Use of Geriatric-Specific Trauma Team Activation Guidelines : Who Are We Missing?. The American surgeon, 87(3), 419–426. https://doi.org/10.1177/0003134820951450
Medicine and Health Sciences
Department of Surgery