Effect of Geriatric‐Specific Trauma Triage Criteria on Outcomes in Injured Older Adults: A Statewide Retrospective Cohort Study

Abstract

Background In 2009, Ohio’s Department of Public Safety established statewide geriatric triage criteria to be used by emergency medical services for injured patients age ≥70. Our goal was to evaluate the effect of the criteria on patient outcomes. Design A retrospective cohort study of the Ohio Trauma Registry. Setting All hospitals in Ohio. Participants Patients age ≥70 years in the Ohio Trauma Registry from January 2006 through December 2011, 3 years before and 3 years after criteria adoption. Measurements Primary outcomes were in-hospital mortality and discharge to home. Criteria effects were assessed using chi-square tests, multivariable logistic regression, interrupted time series plots and multivariable segmented regression models. Results We included 34,499 patients. After geriatric criteria adoption, the proportion of patients qualifying for trauma center transport increased from 44% to 58%, but EMS transport rates did not change (44% versus 45%). There was no difference in unadjusted mortality (7.1% versus 6.6%) (p=0.098). In adjusted analyses, subjects with ISS<10 demonstrated decreased mortality (3.0% versus 2.5%) (odds ratio 0.81; 95% CI 0.70–0.95; p=0.011). Discharge to home did increase in the adjusted analysis (odds ratio 1.06, 95% CI 1.01–1.11; p=0.016). There were no time-dependent changes for either outcome. Conclusions Although the proportion of older adults meeting criteria for trauma center transport substantially increased with geriatric triage criteria, there were no increases in trauma center transports. Adoption of statewide geriatric triage guidelines did not improve mortality in more severely injured older adults, but was associated with a small decrease in mortality in mild injury (ISS <10) and with an increase in patients discharged to home. Improving outcomes in injured older adults will require further attention to implementation and use of the geriatric-specific criteria.

Out-of-Hospital Triage of Older Adults With Head Injury: A Retrospective Study of the Effect of Adding “Anticoagulation or Antiplatelet Medication Use” as a Criterion

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“…Current literature has a complexity in determining research priorities in the field of improving outcomes for injured older adults. For example, several issues around the field of prehospital triage of silver trauma were identified in the literature (Chang et al, 2008;Cox et al, 2014;Garwe et al, 2017;Ichwan et al, 2015;Kodadek et al, 2015;Lehmann et al, 2009;Nakamura et al, 2012;Newgard et al, 2016;Staudenmayer et al, 2013), however, only some of them were assessed for their impact on outcomes (Caterino et al, 2016;Cox et al, 2014;Staudenmayer et al, 2013). Furthermore, those issues which were investigated for their impact on outcomes showed conflicting evidence.…”

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“…In this issue of the Journal of the American Geriatrics Society, Caterino and colleagues provide the first statewide analysis of one of these trauma triage protocols for elderly adults. 10 The study is important not just because it is the first of its kind, but also because the authors describe what should have happened after adopting the new protocol and what actually happened. Briefly, their data show that adoption of trauma triage criteria for elderly adults in Ohio should have increased the proportion of older adults meeting criteria for trauma center transport from 44% to 58%, but the proportion of older adults transported to trauma centers actually increased by only 1%, and the adoption of the protocol had no effect on survival.…”