Effectiveness of prehospital trauma triage guidelines for the identification of major trauma in elderly motor vehicle crash victims

Scheetz, Linda Jean

doi:10.1067/men.2003.59

Cited by 70 publications

(54 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite awareness of the association between older age and undertriage in trauma patients, studies continue to show that this worrisome trend continues (2,3,18). This is indeed true in the current study, where the UT patients were significantly older than the appropriately triaged or overtriaged population (Table 1).…”

Section: Discussionsupporting

confidence: 67%

Comorbidity-Polypharmacy Score: A Novel Adjunct in Post-Emergency Department Trauma Triage

Justiniano¹,

Evans²,

Beery³

et al. 2012

Journal of Surgical Research

View full text Add to dashboard Cite

OBJECTIVE-Post-emergency department (ED) triage of older trauma patients continues to be challenging as morbidity and mortality for any given level of injury severity tend to increase with age. The Comorbidity-Polypharmacy Score (CPS) combines the number of pre-injury medications with the number of comorbidities to estimate the severity of co-morbid conditions. This retrospective study examines the relationship between CPS and triage accuracy for older (≥45 years) patients admitted for traumatic injury. METHODS-Patients≥ 45 years old presenting to level 1 trauma center from 2005 to 2008 were included. Basic data included patient demographics, injury severity score (ISS), morbidity/ mortality, and functional outcome measures. CPS was calculated by adding total numbers of comorbid conditions and pre-injury medications. Patients were divided into 3 triage groups: undertriage, appropriate triage, and over-triage. Under-triage criteria included initial admission to the floor or step-down unit followed by an unplanned transfer to ICU within 24 hours of admission. Over-triage was defined as initial ICU admission for <1 day without stated need for ICU level of care (i.e., lack of evidence for tracheal intubation/mechanical ventilation, injuryrelated hemorrhage, or other traditional ICU indications such as intracranial bleeding). All other patients were presumed to be correctly triaged. The three triage groups were then analyzed looking for contributors to mis-triage. RESULTS-Charts for 711 patients were evaluated (mean age 63.5, 55.7% male, mean ISS 9.02). Of those, 11 (1.55%) met criteria for "under-triage" and 14 (1.97%) were "over-triaged". The remaining 686 patients had no evidence of mis-triage. The three groups were similar in terms © 2012 Elsevier Inc. All rights reserved. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript of injury severity and age. The groups were significantly different with respect to CPS, with undertriage CPS scores (14.9±6.80) being nearly three times higher than the overtriage CPS scores (5.14±3.48). There were more similarities between appropriate and overtriage groups, with the undertriage group being characterized by greater number of complications, and lower functional outcomes at discharge (all, p<0.05). The undertriage group had significantly higher mortality (27%) than the appropriate and over-triage groups (6% and 0%, respectively).CONCLUSION-In the era of medication reconciliation, the CPS is easy to obtain and calculate in patients who are not...

show abstract

Section: Discussionsupporting

confidence: 67%

Comorbidity-Polypharmacy Score: A Novel Adjunct in Post-Emergency Department Trauma Triage

Justiniano¹,

Evans²,

Beery³

et al. 2012

Journal of Surgical Research

View full text Add to dashboard Cite

show abstract

“…The prehospital advanced life support has been reported to be an important component of trauma care in general and particularly in elderly trauma patients, and plays a vital role in determining the final outcome of treatment when done appropriately (Lane et al, 2003;Jacobs et al, 2003;Scheetz, 2003). In the present study, prehospital treatment was reported in only 5.3% of geriatric injury patients seen at the A&E department as a result the majority of them were brought in by relatives, Good Samaritan and police who are not trained on how to take care these patients during transportation.…”

Section: Discussionmentioning

confidence: 99%

Geriatric injuries among patients attending a regional hospital in Shinyanga Tanzania

Chalya

Mabula

Ngayomela

et al. 2012

Tanzania J Hlth Res

View full text Add to dashboard Cite

Geriatric injuries pose a major challenge to surgeons and general practitioners in developing countries. The objective of this study was to determine the prevalence, injury characteristics and outcomes of geriatric injury among patients at Shinyanga Regional Hospital in Tanzania. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7% of all trauma admissions were studied. The male to female ratio was 1.4:1. Their mean age was 68.5 years (ranged 60-98 years). Premorbid illness was reported in 38.3% of patients. Most injuries were intentional in fifty-three (56.4%) patients. Assaults, falls and road traffic crashes were the mechanism of injuries in 52.1%, 19.1% and 11.7% of cases, respectively. The majority of cases of assault were females accounting for 64.6%. The majority of injuries (81.9%) occurred at home. Pre-hospital care was recorded in 5.3% of cases. The musculoskeletal (72.3%) and head (66.0%) regions were commonly affected. Soft tissue injuries (wounds) (89.4%) and fractures (52.2%) were the most common type of injuries. The majority of patients (90.4%) underwent surgical treatment of which wound debridement was the most common procedure performed in 91.8% of cases. Complication rate was 39.4%. The mean length of hospital stay was 28.6 days (ranged 1 -124 days). The length of hospital stay was significantly longer in patients with co-morbidities, long bone fractures and those with complications (P<0.05). Mortality rate was 14.9% and it was significantly related to advanced age, presence of pre-morbid illness, high injury severity score, severe head injuries and the need for ventilatory support (P< 0.05). In conclusion, traumatic injuries in elderly constitute a major but preventable public health problem in Shinyanga region and contribute significantly to high morbidity and mortality. Urgent preventive measures focusing at the root causes of the injuries and early appropriate treatment is highly needed to reduce the occurrence, morbidity and mortality associated with these injuries. ____________________________________________________________________________________________

show abstract

“…Scheetz reports physiological changes associated with aging and preexisting disease may inhibit accurate assessment of the older trauma patient. 7 In 2004, the American College of Surgeons Committee on Trauma (ACS-COT) recommended that age as well as the existence of preexisting diseases be considered when evaluating trauma patients. 8…”

Section: Preexisting Medical Conditionsmentioning

confidence: 99%

When the trauma patient is elderly

Stevenson

2004

Journal of PeriAnesthesia Nursing

View full text Add to dashboard Cite

Effectiveness of prehospital trauma triage guidelines for the identification of major trauma in elderly motor vehicle crash victims

Cited by 70 publications

References 5 publications

Comorbidity-Polypharmacy Score: A Novel Adjunct in Post-Emergency Department Trauma Triage

Comorbidity-Polypharmacy Score: A Novel Adjunct in Post-Emergency Department Trauma Triage

Geriatric injuries among patients attending a regional hospital in Shinyanga Tanzania

When the trauma patient is elderly

Contact Info

Product

Resources

About