The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Abstract

The value of the trauma mechanism in the triage of severely injured elderly Nijboer, J.M.M.; van der Sluis, Corry K.; Dijkstra, Pieter U. ; ten Duis, H.J. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Abstract Background: The triage of trauma patients is currently based on the trauma mechanism. However, it is known that elderly patients can sustain severe injuries due to insignificant trauma mechanisms. As such, triage methods might be questionable. Objective: To evaluate whether current trauma triage criteria are appropriate in severely injured elderly patients. Methods: To analyze the effect of the trauma mechanism on triage and treatment, consecutive patients ‡ 55 years of age, with an injury severity score > 15, treated from 2002 to 2005 were divided into those who sustained a high-energy trauma (HET) versus a low energy trauma (LET). Pre-hospital and in-hospital data, injury characteristics, and data on mortality and disablement one year postinjury (sickness impact profile) were analyzed for HET and LET groups. Results: Age, sex and co-morbidity rate were similar in 84 HET patients and 107 LET patients. HET patients (mean ISS 28) received more sophisticated trauma care than LET patients (mean ISS 22), although mortality was similar (38 vs. 34%). Long-term disablement was also similar (median SIP scores 4 vs. 6). Severe head injuries and the Revised Trauma Score were related to mortality. Physical disablement was related to preexisting co-morbidities. No variables were related to psychosocial disablement. Conclusions: In elderly people a low energy trauma may lead to severe consequences. Not only the trauma mechanism, but also age, co-morbidity, and the likelihood of a brain injury should be leading in the triage and subsequent management of severely injured elderly.

Comparison of injury patterns in road traffic accidents for elderly and very elderly trauma patients in Malaysia

“…Secondly, a majority of patients had head and neck injuries and half of non-survivors died due to head and neck injuries (n=81/158, 51.2%). Consistent with past findings, 34,53,54,55,56 head trauma remained as a strong indicator of adverse outcome for injured geriatric trauma patients. While injury to extremity region was reported as the most common part of injured region following road traffic accidents in general population, 57,58,59,60,61 a substantial number of head injury cases were reported among geriatric trauma patients in this study.…”

Accurate Triage and Specialized Assessment Needs of the Geriatric Trauma Patient Who Experiences Low-Energy Trauma

“…For example, it is widely held that the physiological reserve across all major organs declines with aging. 4 In addition, the common use of medications such as Beta blockers limits the ability of an elderly patient to mount normal systemic manifestations of shock, namely hypotension and tachycardia." 3 Other considerations are osteoporosis increasing the likelihood of bone fractures, and pneumonia due to loss of elasticity in the pulmonary system.…”

“…An HET patient's injuries are not as obscured by pathophysiological response and include major trauma, which dictates the rapid transfer of these patients to appropriate trauma centers. 4 Often, geriatric LET patients are not immediately transported to trauma facilities; they are delayed, spending time moving through the emergency department before being transported to tertiary care facilities. 4 Other than elevated blood pressure due to her chronic hypertension, Mrs. Smith's vital signs are noted to be within normal limits.…”

“…4 Often, geriatric LET patients are not immediately transported to trauma facilities; they are delayed, spending time moving through the emergency department before being transported to tertiary care facilities. 4 Other than elevated blood pressure due to her chronic hypertension, Mrs. Smith's vital signs are noted to be within normal limits. She is not on beta blockers that would mask symptoms of shock.…”

“…Geriatric patients who are not appropriately triaged to their level of injuries experience delays in care. [1][2][3][4] Discussion Triage, or prioritization of patients according to the severity of their injuries, occurs prehospital and once again when the patient arrives in the acute-care setting. Undertriage can be defined as prioritizing the patient as less injured than what is revealed after examination, or, in the prehospital setting, it can be defined as not transporting an injured patient to the appropriate trauma-certified center deemed necessary for the injury detected after examination.…”