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Evaluation of a New Elderly Trauma Triage Algorithm

James S. Davis, MD, Bassan J. Allan, MD, MBA, Olu Sobowale, MD, Felicia Ivascu, MD, Kristine Orion, RN, Carl I. Schulman, MD, PhD
Volume: 105 Issue: 9 September, 2012

Abstract:

Objectives: Undertriage is common in patients 55 years and older and is even worse for those 65 and older. In 1999, the Florida legislature implemented a statewide trauma system, including a new Florida trauma triage algorithm (FTTA). This study examines how the new system affected prehospital triage in younger versus older patients.


Methods: A retrospective review of appropriate triage was conducted at a regional level 2 trauma center during a 1-year period. Patients were considered to have major trauma if they were FTTA positive or had an Injury Severity Score (ISS) of ≥16. An internal trauma review panel examined hospital discharge data to assess triage accuracy. Odds ratios (ORs) and confidence intervals (CIs) were calculated.


Results: A total of 49% of nontrauma patients 15 to 54 years old were seen at the trauma center compared with 83% of FTTA positive and 86% of patients with an ISS ≥16 (OR 2.88, 95% CI 2.44–3.41). For those with an ISS ≥16, the OR was 6.53 (95% CI 4.07–10.47). For patients 55 years and older, 52% of nontrauma patients were triaged to the trauma center versus 59% of FTTA positive and 64% of patients with ISS ≥16 (OR 1.03, 95% CI 0.93–1.15). Patients 55 years and older with an ISS ≥16 had only a slightly increased triage effect (OR 1.67, 95% CI 1.08–2.58) compared with those with an ISS 0 to 15 (OR 1.00, 95% CI 0.89–1.12).


Conclusions: Whereas FTTA appropriately triaged patients 15 to 54 years old to the trauma center, those 55 years old and older were much less likely to be triaged correctly. The reasons for this finding remain unknown, and further studies are needed to investigate and improve elderly triage.

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