Should Age Be a Factor to Change From a Level II to a Level I Trauma Activation?

Abstract

Patients with an ISS between 0 and 15 are often triaged to Level II activation. Our data would suggest that patients older than 60 years should be a criterion for the highest level of trauma activation.

Geriatric trauma service

“…4 Data from the National Trauma Databank have shown that elderly trauma patients have a threefold increase in morbidity and a fivefold increase in mortality with minor ISS, whereas they have a twofold increase in morbidity and a fourfold increase in mortality with major ISS. 5 Another study showed an 11.4% mortality rate in trauma patients age older than 65 years compared with patients aged 18 to 35 years who only had a mortality rate of 2.4%. 4 The trauma death rate per 100,000 people per year is 56.0 for all age groups combined.…”

“…2,4 Geriatric trauma patients have significantly worse outcomes compared with younger patients. 5 Therefore, trauma care given to these patients should be distinctively different from care given to their younger cohorts. Thus, the purpose of this study was to evaluate the effectiveness of a multidisciplinary trauma service model (G-60) aimed at improving elderly trauma patient outcomes.…”

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

“…Ideally, patients with major trauma are triaged to the highest level of trauma care, that is, a level I trauma team activation (TTA), based on triage guidelines. However, some patients who present with certain risk factors are not assigned a level I TTA despite the severity of injuries 8. The group of patients with an ISS >15 who do not receive level I TTA are termed “undertriaged”.…”

The effectiveness of a statewide trauma call center in reducing time to definitive care for severely injured patients

“…Interestingly, we found that older age was associated with the nonuse of the call center and delay in time to definitive care. Shifflette et al 9 found that geriatric patients have worse outcomes, even with minimal injury (ISS G 15) and suggest that patients older than 60 years be activated at the highest level. The lack of call center use and outcomes in this patient population need further exploration.…”