Comparison of Type and Severity of Major Injuries among Undertriaged and Correctly Triaged Older Patients

Scheetz, Linda Jean

doi:10.1016/j.jemermed.2011.09.036

Cited by 15 publications

(13 citation statements)

References 20 publications

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“…Similarly, Scheetz found undertriage rates of 26% among adults aged 65 and older, and that most of the undertriaged had a TBI. 35 Evidence that special care is needed for older adults was demonstrated by Roudsari et al In this study, it was shown that CT utilization had increased twofold over a 10-year period for older adult patients with fall-related injuries, including non-TBIs. 37 …”

Section: Discussionmentioning

confidence: 64%

“…One study reports that 7 of the 60 patients that had an expanding epidural or subdural hematoma were considered too unstable to transport and needed an emergency craniotomy in the form of a burr hole decompression. 35 These patients were later transferred to a trauma center. The authors of the study concluded that the emergency services provided by non-neurosurgeons saved lives and reduced morbidity in properly selected cases, when timely access to a neurosurgeon was not possible.…”

Section: Discussionmentioning

confidence: 99%

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Hospitalized Traumatic Brain Injury: Low Trauma Center Utilization and High Interfacility Transfers among Older Adults

Faul¹,

Xu²,

Sasser³

2016

Prehospital Emergency Care

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Objective Guidelines suggest that Traumatic Brain Injury (TBI) related hospitalizations are best treated at Level I or II trauma centers because of continuous neurosurgical care in these settings. This population-based study examines TBI hospitalization treatment paths by age groups. Methods Trauma center utilization and transfers by age groups were captured by examining the total number of TBI hospitalizations from National Inpatient Sample (NIS) and the number of TBI hospitalizations and transfers in the Trauma Data Bank National Sample Population (NTDB-NSP). TBI cases were defined using diagnostic codes. Results Of the 351,555 TBI related hospitalizations in 2012, 47.9% (n = 168,317) were directly treated in a Level I or II trauma center, and an additional 20.3% (n = 71,286) were transferred to a Level I or II trauma center. The portion of the population treated at a trauma center (68.2%) was significantly lower than the portion of the U.S. population who has access to a major trauma center (90%). Further, nearly half of all transfers to a Level I or II trauma center were adults aged 55 and older (p < 0.001) and that 20.2% of pediatric patients arrive by non-ambulatory means. Conclusion Utilization of trauma center resources for hospitalized TBIs may be low considering the established lower mortality rate associated with treatment at Level I or II trauma centers. The higher transfer rate for older adults may suggest rapid decline amid an unrecognized initial need for a trauma center care. A better understanding of hospital destination decision making is needed for patients with TBI.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Hospitalized Traumatic Brain Injury: Low Trauma Center Utilization and High Interfacility Transfers among Older Adults

Faul¹,

Xu²,

Sasser³

2016

Prehospital Emergency Care

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“…Worldwide, 26-67% of patients with a severe head injury are not transported to a higher-level trauma centre [9][10][11]20,24]. The percentage depends greatly on the inclusion criteria, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies show that many patients with severe head trauma are not transported to a higher-level trauma centre [9][10][11][12][13]. The ability of EMS providers to accurately identify patients with a head injury is Correspondence unknown.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of emergency medical services provider judgement in the identification of head injuries among trauma patients

Rein¹,

Jochems²,

Lokerman³

et al. 2018

Euro J of Neurology

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“…Previous studies show that field triage and compliance varies among age groups [22,[33][34][35]. Triage criteria are less sensitive for paediatric patients; however, the EMS are more easily inclined to transport a paediatric patient to a level I trauma centre, compared to adult patients [24].…”

Section: Discussionmentioning

confidence: 99%

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

Rein

Sadiqi

Lansink

et al. 2018

Eur J Trauma Emerg Surg

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Purpose Severely injured patients should be treated at higher-level trauma centres, to improve chances of survival and avert life-long disabilities. Emergency medical service (EMS) providers must try to determine injury severity on-scene, using a prehospital trauma triage protocol, and decide the most appropriate type of trauma centre. The objective of this study is to investigate the role of EMS provider judgment in the prehospital triage process of trauma patients, by analysing the compliance rate to the protocol and administering a questionnaire among EMS providers. Methods All trauma patients transported to a trauma centre in two different regions of the Netherlands were analysed. Compliance rate was based on the number of patients meeting the triage criteria and transported to the corresponding level trauma centre. The questionnaire was administered among EMS providers. Descriptive statistics were used to analyse the data. Results For adult patients, the compliance rate to the level I criteria of the triage protocol was 72% in Central Netherlands and 42% in Brabant. For paediatric patients, this was 63% and 38% in Central Netherlands and Brabant, respectively. The judgment on injury severity was mostly based on the injury-type criteria. Additionally, the distance to a level I trauma centre influenced the decision for destination facility in the Brabant region. Conclusion The compliance rate varied between regions. Improvement of prehospital trauma triage depends on the accuracy of the protocol and compliance rate. A new protocol, including EMS provider judgment, might be the key to improvement in the prehospital trauma triage quality.

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Comparison of Type and Severity of Major Injuries among Undertriaged and Correctly Triaged Older Patients

Cited by 15 publications

References 20 publications

Hospitalized Traumatic Brain Injury: Low Trauma Center Utilization and High Interfacility Transfers among Older Adults

Hospitalized Traumatic Brain Injury: Low Trauma Center Utilization and High Interfacility Transfers among Older Adults

Diagnostic value of emergency medical services provider judgement in the identification of head injuries among trauma patients

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

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