Trauma Team Activation for Geriatric Trauma at a Level II Trauma Center: Are the Elderly Under-triaged?

BackgroundThe elderly trauma patient has increased mortality compared with younger patients. During the last 15 years, initial treatment of severely injured patients at Oslo University Hospital Ulleval (OUHU) has changed resulting in overall improved outcomes. Whether this holds true for the elderly trauma population needs exploration and was the aim of the present study.MethodsWe performed a retrospective study of 2628 trauma patients 61 years or older admitted to OUHU during the 12-year period, 2002–2013. The population was stratified based on age (61–70 years, 71–80 years, 81 years and older) and divided into time periods: 2002–2009 (P1) and 2010–2013 (P2). Multiple logistic regression models were constructed to identify clinically relevant core variables correlated with mortality and trauma team activation rate.ResultsCrude mortality decreased from 19% in P1 to 13% in P2 (p<0.01) with an OR of 0.77 (95 %CI 0.65 to 0.91) when admitted in P2. Trauma team activation rates increased from 53% in P1 to 72% in P2 (p<0.01) with an OR of 2.16 (95% CI 1.93 to 2.41) for being met by a trauma team in P2. Mortality increased from 10% in the age group 61–70 years to 26% in the group above 80 years. Trauma team activation rates decreased from 71% in the age group 61–70 years to 50% in the age group older than 80 years. Median ISS were 17 in all three age groups and in both time periods.DiscussionDevelopment of a multidisciplinary dedicated trauma service is associated with increased trauma team activation rate as well as survival in geriatric trauma patients. As expected, mortality increased with age, although inversely related to the likelihood of being met by a trauma team. Trauma team activation should be considered for all trauma patients older than 70 years.Level of evidenceLevel IV.

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Implementation of the American College of Surgeons Committee on Trauma's Trauma Team Activation Criteria at a Level II Trauma Center Improves Under-Triage for Severely Injured Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2018.08.636 ◽

2018 ◽

Vol 227 (4) ◽

pp. e235

Author(s):

Alicia A. Heelan Gladden ◽

Erik D. Peltz ◽

Robert C. McIntyre ◽

Stephanie Vega ◽

Catherine G. Velopulos ◽

...

Keyword(s):

Trauma Center ◽

Trauma Team ◽

Severely Injured ◽

Severely Injured Patients ◽

Trauma Team Activation ◽

Level Ii ◽

American College Of Surgeons ◽

Activation Criteria ◽

Injured Patients

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Suburban geriatric trauma: the experiences of a level I trauma center

American Journal of Critical Care ◽

10.4037/ajcc1995.4.5.379 ◽

1995 ◽

Vol 4 (5) ◽

pp. 379-382 ◽

Cited By ~ 9

Author(s):

F DeKeyser ◽

D Carolan ◽

A Trask

Keyword(s):

Trauma Center ◽

Functional Outcomes ◽

Injury Severity ◽

The Elderly ◽

Mortality Rates ◽

Geriatric Trauma ◽

Trauma Patients ◽

Younger Patients ◽

Severity Scores ◽

Trauma Scores

BACKGROUND: As the mean age of the US population increases, so does the incidence of geriatric trauma. Investigators have shown that the elderly have high morbidity and mortality rates associated with traumatic injuries. OBJECTIVE: To compare the severity of injury, mortality, and functional outcomes of geriatric patients with younger patients admitted to a suburban trauma center. METHOD: A convenience sample of trauma patients who were 65 years old or older was compared with trauma patients who were 35 to 45 and 55 to 64 years old. Demographic data, injury data, Injury Severity Scores, Revised Trauma Scores, length of stay, and functional ability outcomes were abstracted from a trauma registry in aggregate form and then analyzed. RESULTS: The sample consisted of 766 subjects (age 35-45, n = 223; age 55-64, n = 135; age 65 and older, n = 408) with a mean age of 64.6 years. A larger percentage of the elderly were victims of falls; younger trauma patients were more likely to be victims of motor vehicle crashes. Significant differences were found between age groups on Glasgow Coma Scale scores. Revised Trauma Scores, and length of stay. Significant differences were not found on Injury Severity Scores, mortality rates, or functional outcomes. CONCLUSIONS: Although anatomic injury severity of elderly patients was similar to that of younger patients, the elderly demonstrated greater physiologic compromise and longer hospital stays. Mortality rates were lower for the elderly group, but this result might be because a larger proportion of elderly patients were hospitalized with minor or moderate injuries.

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Geriatric Patients on Antithrombotic Agents who Fall: Does Trauma Team Activation Improve Outcomes?

The American Surgeon ◽

10.1177/000313481908500730 ◽

2019 ◽

Vol 85 (7) ◽

pp. 721-724

Author(s):

Peter Hwang ◽

Adrian W. Ong ◽

Alison Muller ◽

Amanda Mcnicholas ◽

Anthony Martin ◽

...

Keyword(s):

Logistic Regression ◽

Propensity Score ◽

Geriatric Patients ◽

Propensity Score Analysis ◽

Trauma Team ◽

The Elderly ◽

Severely Injured ◽

Severely Injured Patients ◽

Trauma Team Activation ◽

Injured Patients

Despite the incorporation of anticoagulant and antiplatelet (ACAP) drugs in our trauma triage criteria, it is unclear whether trauma team activation (TTA) impacts outcomes in geriatric patients on ACAP drugs sustaining falls. We hypothesized that TTA in this cohort was associated with improved outcomes. The hospital electronic database was queried to identify normotensive, awake patients aged ≥65 years on ACAP agent from 2014 to 2018 presenting to the emergency department after falls. The outcome was in-hospital mortality. The association between TTA and mortality was examined using logistic regression analysis and 1:1 propensity score matching analysis. In this study, 4540 patients on ACAP drugs were analyzed, with TTA occurring in 500 (11%). TTA occurred in younger but more severely injured patients with lower Glasgow Coma Score. Logistic regression revealed that TTA was not associated with mortality (odds ratio [95% confidence intervals], 2.04 [0.89–4.25]). The 1:1 propensity score analysis revealed similar mortality for the matched groups (non-TTA, 1.6% vs TTA, 2.2%, P = 0.64). In the elderly patients on ACAP agents, the current triage criteria resulted in the appropriate use of TTA for more severely injured patients. The lack of outcome benefit suggests that ACAP drug use as a criterion for TTA should be re-evaluated.

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