Survival Benefit of Treatment at or Transfer to a Tertiary Trauma Center among Injured Older Adults

Garwe, Tabitha; Stewart, Katharine E.; Newgard, Craig D.; Stoner, Julie A.; Sacra, John C.; Cody, Patrick; Oluborode, Babawale; Albrecht, Roxie M.

doi:10.1080/10903127.2019.1632997

Cited by 33 publications

(39 citation statements)

References 36 publications

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“…Most of the included studies were conducted in the USA (n = 21) [36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. Eleven studies were published in the last five years [41, 43-45, 47, 50, 52, 55-58], four of which were published in 2020 [41,[55][56][57]. All studies were retrospective cohort studies and only one study additionally included a survey (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Under-triage of older trauma patients in prehospital care: a systematic review

2021

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Background It is argued that many older trauma patients are under-triaged in prehospital care which may adversely affect their outcomes. This systematic review aimed to assess prehospital under-triage rates for older trauma patients, the accuracy of the triage criteria, and the impact of prehospital triage decisions on outcomes. Methods A computerised literature search using MEDLINE, Scopus, and CINHAL databases was conducted for studies published between 1966 and 2021 using a list of predetermined index terms and their associated alternatives. Studies which met the inclusion criteria were included and critiqued using the Critical Appraisal Skills Programme tool. Due to the heterogeneity of the included studies, narrative synthesis was used in this systematic review. Results Of the 280 identified studies, 23 met the inclusion criteria. Current trauma triage guidelines have poor sensitivity to identify major trauma and the need for TC care for older adults. Although modified triage tools for this population have improved sensitivity, they showed significantly decreased specificity or were not applied to all older people. The issue of low rates of TC transport for positively triaged older patients is not well understood. Furthermore, the benefits of TC treatment for older patients remain uncertain. Conclusions This systematic review showed that under-triage is an ongoing issue for older trauma patients in prehospital care and its impact on their outcomes is still uncertain. Further high-quality prospective research is needed to assess the accuracy of prehospital triage criteria, the factors other than the triage criteria that affect transport decisions, and the impact of under-triage on outcomes.

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Section: Resultsmentioning

confidence: 99%

Under-triage of older trauma patients in prehospital care: a systematic review

2021

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“…Previous evidence showed survival benefit for the treatment of older trauma patients of different age groups at MTCs compared to non-MTCs (Table 3). [65][66][67] However, some other studies showed no significant advantage of such access for older trauma patients 68 and that the treatment at non-MTC was associated with more than 4-fold increase in the likelihood of survival (Table 3). 69 It was shown that the admission of older trauma patients to MTCs was associated with lengthier in-hospital stay than non-MTCs (Table 3).…”

Section: Determining the Benefits Of Major Trauma Centres Accessmentioning

confidence: 99%

“…Although most of these studies showed some benefit of MTC access for older adults, generalizing these results may not be appropriate as these studies had variations in the datasets that were used for analysis, included different patient populations in different trauma systems, and assessed different outcome measures. Furthermore, some of these studies did not adjust for some important confounders such as physiological factors, comorbidities, and mechanism of injury, 66 , 67 , 69 , 70 included small number of patients, 68 excluded transfers, 67 focused on single pattern of injury, 70 and did not track deaths post hospital discharge within a defined period 65 - all of which make comparisons difficult.…”

Section: Determining the Benefits Of Major Trauma Centres Accessmentioning

confidence: 99%

“…populations in different trauma systems, and assessed different outcome measures. Furthermore, some of these studies did not adjust for some important confounders such as physiological factors, comorbidities, and mechanism of injury, 66,67,69,70 included small number of patients, 68 excluded transfers, 67 focused on single pattern of injury, 70 and did not track deaths post hospital discharge within a defined period 65 -all of which make comparisons difficult.…”

Section: 988mentioning

confidence: 99%

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New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Alshibani¹,

Banerjee²,

Lecky³

et al. 2021

OAEM

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Caring for older people is an important part of prehospital practice, including appropriate triage and transportation decisions. However, prehospital triage criteria are designed to predominantly assess injury severity or high-energy mechanism which is not the case for older people who often have injuries compounded by multimorbidity and frailty. This has led to high rates of under-triage in this population. This narrative review aimed to assess aspects other than triage criteria to better understand and improve prehospital triage decisions for older trauma patients. This includes integrating frailty assessment in prehospital trauma triage, which was shown to predict adverse outcomes for older trauma patients. Furthermore, determining appropriate outcome measures and the benefits of Major Trauma Centers (MTCs) for older trauma patients should be considered in order to direct accurate and more beneficial prehospital trauma triage decisions. It is still not clear what are the appropriate outcome measures that should be applied when caring for older trauma patients. There is also no strong consensus about the benefits of MTC access for older trauma patients with regards to survival, in-hospital length of stay, discharge disposition, and complications. Moreover, looking into factors other than triage criteria such as distance to MTCs, patient or relative choice, training, unfamiliarity with protocols, and possible ageism, which were shown to impact prehospital triage decisions but their impact on outcomes has not been investigated yet, should be more actively assessed and investigated for this population. Therefore, this paper aimed to discuss the available evidence around frailty assessment in prehospital care, appropriate outcome measures for older trauma patients, the benefits of MTC access for older patients, and factors other than triage criteria that could adversely impact accurate prehospital triage decisions for older trauma patients. It also provided several suggestions for the future.

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“…It should be noted that, delaying transfer for taking laboratory tests could postpone or fail the process of deterministic treatment. [44]…”

Section: Methodsmentioning

confidence: 99%

Management of multiple traumas in emergency medicine department: A review

Kashani

Saberinia

2019

J Family Med Prim Care

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One of the main causes of adults' disability during their working age is multiple trauma. The process of medical care of patients who are injured seriously is still a challenging job. The primary treatment of these patients in the emergency medicine departments is the most required choice after the wilderness first aid and also would be very required before definitive care in the hospital. The main aim of emergency medicine departments is quick recognition and treatment of injuries which pose severe threat to patients' life in appropriate order of priority. The procedure of primary evaluation in emergency medicine department with the help of medical routine examination and ultrasonography is based on the concept of focused assessment with sonography in trauma (FAST) for identifying spontaneous intraperitoneal hemorrhage. Emergency patients who suffer from massive hematothorax, serious lung and heart traumas, and penetrating traumas to the chest would undergo thoracotomy and patients who have few symptoms of perforated hollow viscous will undergo emergency laparotomy. Based on the trauma severity, emergency treatment could be the way to fast recovery of the structure of injured organ and its function. The subsequent goal, in the acute phase, will concentrate on preventing and stopping bleeding and secondary injuries like painful compartment syndrome or intra-abdominal infections (IAIs). However, the main aim of emergency medicine department in taking care of severely injured patients is the management of airway, protecting circulation and breathing, identification of neurologic problems, and whole body clinical examination with the help of healthcare providers.

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Survival Benefit of Treatment at or Transfer to a Tertiary Trauma Center among Injured Older Adults

Cited by 33 publications

References 36 publications

Under-triage of older trauma patients in prehospital care: a systematic review

Under-triage of older trauma patients in prehospital care: a systematic review

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Management of multiple traumas in emergency medicine department: A review

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