| Autor: |
Benhamed A; Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 69123 Lyon, France., Emond M; Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1J 1Z4, Canada., Mercier E; Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1J 1Z4, Canada., Heidet M; SAMU 94, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 75610 Paris, France., Gauss T; Anaesthesia Critical Care, Grenoble Alpes University Hospital, 38700 Grenoble, France., Saint-Supery P; Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 69123 Lyon, France., Yadav K; Department of Emergency Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada., David JS; Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France.; Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69100 Lyon, France., Claustre C; RESUVal Trauma Network, Centre Hospitalier Lucien Hussel, 38200 Vienne, France., Tazarourte K; Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 69123 Lyon, France.; Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69100 Lyon, France. |
| Abstrakt: |
Background : Prehospital trauma triage tools are not tailored to identify severely injured older adults. Our trauma triage protocol based on a three-tier trauma severity grading system (A, B, and C) has never been studied in this population. The objective was to assess its accuracy in predicting in-hospital mortality among older adults (≥65 years) and to compare it to younger patients. Methods : A retrospective multicenter cohort study, from 2011 to 2021. Consecutive adult trauma patients managed by a mobile medical team were prospectively graded A, B, or C according to the initial seriousness of their injuries. Accuracy was evaluated using sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Results : 8888 patients were included (14.1% were ≥65 years). Overall, 10.1% were labeled Grade A (15.2% vs. 9.3% among older and younger adults, respectively), 21.9% Grade B (27.9% vs. 20.9%), and 68.0% Grade C (56.9% vs. 69.8%). In-hospital mortality was 7.1% and was significantly higher among older adults regardless of severity grade. Grade A showed lower sensitivity (50.5 (43.7; 57.2) vs. 74.6 (69.8; 79.1), p < 0.0001) for predicting mortality among older adults compared to their younger counterparts. Similarly, Grade B was associated with lower sensitivity (89.5 (84.7; 93.3) vs. 97.2 (94.8; 98.60), p = 0.0003) and specificity (69.4 (66.3; 72.4) vs. 74.6 (73.6; 75.7], p = 0.001) among older adults. Conclusions : Our prehospital trauma triage protocol offers high sensitivity for predicting in-hospital mortality including older adults. |
