The Impact of Under-triage on Trauma Outcomes in Older Populations ≥65 Years
| Autor: | Milad Modarresi, Chelsea M. Knotts, Bryan K. Richmond, Damayanti Samanta |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Aged
80 and over Male medicine.medical_specialty business.industry Persistent Vegetative State Glasgow Coma Scale Human factors and ergonomics Poison control General Medicine Wounds Nonpenetrating Suicide prevention Triage Occupational safety and health Injury Severity Score Injury prevention Emergency medicine Humans Medicine Female Hospital Mortality business Aged Retrospective Studies |
| Zdroj: | The American Surgeon. 87:1412-1419 |
| ISSN: | 1555-9823 0003-1348 |
| DOI: | 10.1177/0003134820951456 |
| Popis: | Background Undertriage of older trauma patients is implicated as a cause for outcome disparities. Undertriage is defined by an Injury Severity Score (ISS) ≥16 without full trauma activation. We hypothesized that in patients ≥65 years, undertriage is associated with unfavorable discharge. Methods This is a retrospective study of patients ≥65 years admitted at a Level 1 Trauma Center between July 2016 and June 2018 with blunt trauma. The Matrix method was used to determine the undertriage rate, and outcomes were compared between undertriaged and fully activated patients with ISS ≥16. Favorable outcomes in undertriaged patients instigated further analyses to determine factors that predicted unfavorable discharge condition, defined by discharge from the hospital with severe disability, persistent vegetative state, and in-hospital death. Results The undertriage rate was 7.9%. When compared to fully activated patients with ISS ≥16, a lower percentage of undertriaged patients were discharged in an unfavorable condition (16.6% vs 64.7%, P < .001). On the multivariate analysis, male sex (OR = 1.52), preexisting coronary artery disease (OR = 1.86), age >90 years (OR = 2.31), ISS 16-25 (OR = 3.50), Glasgow Coma Score (GCS) ≤14 (OR = 6.34), and ISS >25 (OR = 9.64) were significant independent risk factors for unfavorable discharge. Discussion The undertriage rate in patients ≥65 years was higher than the accepted standard (5%). However, undertriaged patients had better outcomes than those fully activated with ISS ≥16. Factors more predictive of unfavorable discharge condition were GCS ≤14 and ISS >25. These data suggest that ISS alone is a poor marker for assessing undertriage in older patients. Additional parameters established in this study should be considered as potential markers for better predicting outcomes in older trauma patients. |
| Databáze: | OpenAIRE |
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