TY - JOUR
T1 - Triage of elderly trauma patients
T2 - A population-based perspective
AU - Staudenmayer, Kristan L.
AU - Hsia, Renee Y.
AU - Mann, N. Clay
AU - Spain, David A.
AU - Newgard, Craig D.
N1 - Funding Information:
Supported by the Robert Wood Johnson Foundation Physician Faculty Scholars Program ; the Oregon Clinical and Translational Research Institute (grant # UL1 RR024140 ); Stanford Center for Clinical and Translational Education and Research (grant # 1UL1 RR025744 ); University of Utah Center for Clinical and Translational Science (grant # UL1-RR025764 and C06-RR11234 ); and UCSF Clinical and Translational Science Institute (grant # UL1 RR024131 ). All Clinical and Translational Science Awards are from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.
PY - 2013/10
Y1 - 2013/10
N2 - Background Elderly patients are frequently undertriaged. However, the associations between triage patterns and outcomes from a population perspective are unknown. We hypothesized that triage patterns would be associated with differences in outcomes. Study Design This is a population-based, retrospective, cohort study of all injured adults aged 55 years or older, from 3 counties in California and 4 in Utah (2006 to 2007). Prehospital data were linked to trauma registry data, state-level discharge data, emergency department records, and death files. The primary outcome was 60-day mortality. Patients treated at trauma centers were compared with those treated at nontrauma centers. Undertriage was defined as an Injury Severity Score (ISS) >15, with transport to a nontrauma center. Results There were 6,015 patients in the analysis. Patients who were taken to nontrauma centers were, on average, older (79.4 vs 70.& years, p < 0.001), more often female (68.6% vs 50.2%, p < 0.01), and less often had an ISS >15 (2.2% vs 6.7%, p < 0.01). There were 244 patients with an ISS >15 and the undertriage rate was 32.8% (n = 80). Overall 60-day mortality for patients with an ISS >15 was 17%, with no difference between trauma and nontrauma centers in unadjusted or adjusted analyses. However, the median per-patient costs were $21,000 higher for severely injured patients taken to trauma centers. Conclusions This is the first population-based analysis of triage patterns and outcomes in the elderly. We have shown high rates of undertriage that are not associated with higher mortality, but are associated with higher costs. Future work should focus on determining how to improve outcomes for this population.
AB - Background Elderly patients are frequently undertriaged. However, the associations between triage patterns and outcomes from a population perspective are unknown. We hypothesized that triage patterns would be associated with differences in outcomes. Study Design This is a population-based, retrospective, cohort study of all injured adults aged 55 years or older, from 3 counties in California and 4 in Utah (2006 to 2007). Prehospital data were linked to trauma registry data, state-level discharge data, emergency department records, and death files. The primary outcome was 60-day mortality. Patients treated at trauma centers were compared with those treated at nontrauma centers. Undertriage was defined as an Injury Severity Score (ISS) >15, with transport to a nontrauma center. Results There were 6,015 patients in the analysis. Patients who were taken to nontrauma centers were, on average, older (79.4 vs 70.& years, p < 0.001), more often female (68.6% vs 50.2%, p < 0.01), and less often had an ISS >15 (2.2% vs 6.7%, p < 0.01). There were 244 patients with an ISS >15 and the undertriage rate was 32.8% (n = 80). Overall 60-day mortality for patients with an ISS >15 was 17%, with no difference between trauma and nontrauma centers in unadjusted or adjusted analyses. However, the median per-patient costs were $21,000 higher for severely injured patients taken to trauma centers. Conclusions This is the first population-based analysis of triage patterns and outcomes in the elderly. We have shown high rates of undertriage that are not associated with higher mortality, but are associated with higher costs. Future work should focus on determining how to improve outcomes for this population.
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U2 - 10.1016/j.jamcollsurg.2013.06.017
DO - 10.1016/j.jamcollsurg.2013.06.017
M3 - Article
C2 - 24054408
AN - SCOPUS:84884504667
SN - 1072-7515
VL - 217
SP - 569
EP - 576
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 4
ER -