Improving early identification of the high-risk elderly trauma patient by emergency medical services

Craig Newgard, James F. Holmes, Jason S. Haukoos, Eileen M. Bulger, Kristan Staudenmayer, Lynn Wittwer, Eric Stecker, Mengtao Dai, Renee Y. Hsia

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Study objective We sought to (1) define the high-risk elderly trauma patient based on prognostic differences associated with different injury patterns and (2) derive alternative field trauma triage guidelines that mesh with national field triage guidelines to improve identification of high-risk elderly patients. Methods This was a retrospective cohort study of injured adults ≥65 years transported by 94 EMS agencies to 122 hospitals in 7 regions from 1/1/2006 through 12/31/2008. We tracked current field triage practices by EMS, patient demographics, out-of-hospital physiology, procedures and mechanism of injury. Outcomes included Injury Severity Score ≥ 16 and specific anatomic patterns of serious injury using abbreviated injury scale score ≥3 and surgical interventions. In-hospital mortality was used as a measure of prognosis for different injury patterns. Results 33,298 injured elderly patients were transported by EMS, including 4.5% with ISS ≥ 16, 4.8% with serious brain injury, 3.4% with serious chest injury, 1.6% with serious abdominal-pelvic injury and 29.2% with serious extremity injury. In-hospital mortality ranged from 18.7% (95% CI 16.7-20.7) for ISS ≥ 16 to 2.9% (95% CI 2.6-3.3) for serious extremity injury. The alternative triage guidelines (any positive criterion from the current guidelines, GCS ≤ 14 or abnormal vital signs) outperformed current field triage practices for identifying patients with ISS ≥ 16: sensitivity (92.1% [95% CI 89.6-94.1%] vs. 75.9% [95% CI 72.3-79.2%]), specificity (41.5% [95% CI 40.6-42.4%] vs. 77.8% [95% CI 77.1-78.5%]). Sensitivity decreased for individual injury patterns, but was higher than current triage practices. Conclusions High-risk elderly trauma patients can be defined by ISS ≥ 16 or specific non-extremity injury patterns. The field triage guidelines could be improved to better identify high-risk elderly trauma patients by EMS, with a reduction in triage specificity.

Original languageEnglish (US)
Pages (from-to)19-25
Number of pages7
JournalInjury
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2016

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Emergency Medical Services
Triage
Wounds and Injuries
Guidelines
Hospital Mortality
Extremities
Abbreviated Injury Scale
Abdominal Injuries
Thoracic Injuries
Injury Severity Score
Vital Signs
Brain Injuries
Cohort Studies
Retrospective Studies
Demography

Keywords

  • Elderly
  • Emergency medical services
  • Trauma
  • Trauma systems
  • Triage

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Newgard, C., Holmes, J. F., Haukoos, J. S., Bulger, E. M., Staudenmayer, K., Wittwer, L., ... Hsia, R. Y. (2016). Improving early identification of the high-risk elderly trauma patient by emergency medical services. Injury, 47(1), 19-25. https://doi.org/10.1016/j.injury.2015.09.010

Improving early identification of the high-risk elderly trauma patient by emergency medical services. / Newgard, Craig; Holmes, James F.; Haukoos, Jason S.; Bulger, Eileen M.; Staudenmayer, Kristan; Wittwer, Lynn; Stecker, Eric; Dai, Mengtao; Hsia, Renee Y.

In: Injury, Vol. 47, No. 1, 01.01.2016, p. 19-25.

Research output: Contribution to journalArticle

Newgard, C, Holmes, JF, Haukoos, JS, Bulger, EM, Staudenmayer, K, Wittwer, L, Stecker, E, Dai, M & Hsia, RY 2016, 'Improving early identification of the high-risk elderly trauma patient by emergency medical services', Injury, vol. 47, no. 1, pp. 19-25. https://doi.org/10.1016/j.injury.2015.09.010
Newgard, Craig ; Holmes, James F. ; Haukoos, Jason S. ; Bulger, Eileen M. ; Staudenmayer, Kristan ; Wittwer, Lynn ; Stecker, Eric ; Dai, Mengtao ; Hsia, Renee Y. / Improving early identification of the high-risk elderly trauma patient by emergency medical services. In: Injury. 2016 ; Vol. 47, No. 1. pp. 19-25.
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abstract = "Study objective We sought to (1) define the high-risk elderly trauma patient based on prognostic differences associated with different injury patterns and (2) derive alternative field trauma triage guidelines that mesh with national field triage guidelines to improve identification of high-risk elderly patients. Methods This was a retrospective cohort study of injured adults ≥65 years transported by 94 EMS agencies to 122 hospitals in 7 regions from 1/1/2006 through 12/31/2008. We tracked current field triage practices by EMS, patient demographics, out-of-hospital physiology, procedures and mechanism of injury. Outcomes included Injury Severity Score ≥ 16 and specific anatomic patterns of serious injury using abbreviated injury scale score ≥3 and surgical interventions. In-hospital mortality was used as a measure of prognosis for different injury patterns. Results 33,298 injured elderly patients were transported by EMS, including 4.5{\%} with ISS ≥ 16, 4.8{\%} with serious brain injury, 3.4{\%} with serious chest injury, 1.6{\%} with serious abdominal-pelvic injury and 29.2{\%} with serious extremity injury. In-hospital mortality ranged from 18.7{\%} (95{\%} CI 16.7-20.7) for ISS ≥ 16 to 2.9{\%} (95{\%} CI 2.6-3.3) for serious extremity injury. The alternative triage guidelines (any positive criterion from the current guidelines, GCS ≤ 14 or abnormal vital signs) outperformed current field triage practices for identifying patients with ISS ≥ 16: sensitivity (92.1{\%} [95{\%} CI 89.6-94.1{\%}] vs. 75.9{\%} [95{\%} CI 72.3-79.2{\%}]), specificity (41.5{\%} [95{\%} CI 40.6-42.4{\%}] vs. 77.8{\%} [95{\%} CI 77.1-78.5{\%}]). Sensitivity decreased for individual injury patterns, but was higher than current triage practices. Conclusions High-risk elderly trauma patients can be defined by ISS ≥ 16 or specific non-extremity injury patterns. The field triage guidelines could be improved to better identify high-risk elderly trauma patients by EMS, with a reduction in triage specificity.",
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AU - Staudenmayer, Kristan

AU - Wittwer, Lynn

AU - Stecker, Eric

AU - Dai, Mengtao

AU - Hsia, Renee Y.

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N2 - Study objective We sought to (1) define the high-risk elderly trauma patient based on prognostic differences associated with different injury patterns and (2) derive alternative field trauma triage guidelines that mesh with national field triage guidelines to improve identification of high-risk elderly patients. Methods This was a retrospective cohort study of injured adults ≥65 years transported by 94 EMS agencies to 122 hospitals in 7 regions from 1/1/2006 through 12/31/2008. We tracked current field triage practices by EMS, patient demographics, out-of-hospital physiology, procedures and mechanism of injury. Outcomes included Injury Severity Score ≥ 16 and specific anatomic patterns of serious injury using abbreviated injury scale score ≥3 and surgical interventions. In-hospital mortality was used as a measure of prognosis for different injury patterns. Results 33,298 injured elderly patients were transported by EMS, including 4.5% with ISS ≥ 16, 4.8% with serious brain injury, 3.4% with serious chest injury, 1.6% with serious abdominal-pelvic injury and 29.2% with serious extremity injury. In-hospital mortality ranged from 18.7% (95% CI 16.7-20.7) for ISS ≥ 16 to 2.9% (95% CI 2.6-3.3) for serious extremity injury. The alternative triage guidelines (any positive criterion from the current guidelines, GCS ≤ 14 or abnormal vital signs) outperformed current field triage practices for identifying patients with ISS ≥ 16: sensitivity (92.1% [95% CI 89.6-94.1%] vs. 75.9% [95% CI 72.3-79.2%]), specificity (41.5% [95% CI 40.6-42.4%] vs. 77.8% [95% CI 77.1-78.5%]). Sensitivity decreased for individual injury patterns, but was higher than current triage practices. Conclusions High-risk elderly trauma patients can be defined by ISS ≥ 16 or specific non-extremity injury patterns. The field triage guidelines could be improved to better identify high-risk elderly trauma patients by EMS, with a reduction in triage specificity.

AB - Study objective We sought to (1) define the high-risk elderly trauma patient based on prognostic differences associated with different injury patterns and (2) derive alternative field trauma triage guidelines that mesh with national field triage guidelines to improve identification of high-risk elderly patients. Methods This was a retrospective cohort study of injured adults ≥65 years transported by 94 EMS agencies to 122 hospitals in 7 regions from 1/1/2006 through 12/31/2008. We tracked current field triage practices by EMS, patient demographics, out-of-hospital physiology, procedures and mechanism of injury. Outcomes included Injury Severity Score ≥ 16 and specific anatomic patterns of serious injury using abbreviated injury scale score ≥3 and surgical interventions. In-hospital mortality was used as a measure of prognosis for different injury patterns. Results 33,298 injured elderly patients were transported by EMS, including 4.5% with ISS ≥ 16, 4.8% with serious brain injury, 3.4% with serious chest injury, 1.6% with serious abdominal-pelvic injury and 29.2% with serious extremity injury. In-hospital mortality ranged from 18.7% (95% CI 16.7-20.7) for ISS ≥ 16 to 2.9% (95% CI 2.6-3.3) for serious extremity injury. The alternative triage guidelines (any positive criterion from the current guidelines, GCS ≤ 14 or abnormal vital signs) outperformed current field triage practices for identifying patients with ISS ≥ 16: sensitivity (92.1% [95% CI 89.6-94.1%] vs. 75.9% [95% CI 72.3-79.2%]), specificity (41.5% [95% CI 40.6-42.4%] vs. 77.8% [95% CI 77.1-78.5%]). Sensitivity decreased for individual injury patterns, but was higher than current triage practices. Conclusions High-risk elderly trauma patients can be defined by ISS ≥ 16 or specific non-extremity injury patterns. The field triage guidelines could be improved to better identify high-risk elderly trauma patients by EMS, with a reduction in triage specificity.

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