The Impact of Under-triage on Trauma Outcomes in Older Populations ≥65 Years

American Surgeon - Tập 87 Số 9 - Trang 1412-1419 - 2021
Chelsea M. Knotts1,2, Milad Modarresi3, Damayanti Samanta4, Bryan K. Richmond1,2
1Department of Surgery, Charleston Area Medical Center, WV, USA
2Department of Surgery, West Virginia University School of Medicine-Charleston Division, WV, USA
3Marshall University, Huntington, WV, USA
4Trauma Research, General Hospital, Charleston Area Medical Center Health Education and Research Institute, WV, USA

Tóm tắt

Background Undertriage of older trauma patients is implicated as a cause for outcome disparities. Undertriage is defined by an Injury Severity Score (ISS) ≥16 without full trauma activation. We hypothesized that in patients ≥65 years, undertriage is associated with unfavorable discharge. Methods This is a retrospective study of patients ≥65 years admitted at a Level 1 Trauma Center between July 2016 and June 2018 with blunt trauma. The Matrix method was used to determine the undertriage rate, and outcomes were compared between undertriaged and fully activated patients with ISS ≥16. Favorable outcomes in undertriaged patients instigated further analyses to determine factors that predicted unfavorable discharge condition, defined by discharge from the hospital with severe disability, persistent vegetative state, and in-hospital death. Results The undertriage rate was 7.9%. When compared to fully activated patients with ISS ≥16, a lower percentage of undertriaged patients were discharged in an unfavorable condition (16.6% vs 64.7%, P < .001). On the multivariate analysis, male sex (OR = 1.52), preexisting coronary artery disease (OR = 1.86), age >90 years (OR = 2.31), ISS 16-25 (OR = 3.50), Glasgow Coma Score (GCS) ≤14 (OR = 6.34), and ISS >25 (OR = 9.64) were significant independent risk factors for unfavorable discharge. Discussion The undertriage rate in patients ≥65 years was higher than the accepted standard (5%). However, undertriaged patients had better outcomes than those fully activated with ISS ≥16. Factors more predictive of unfavorable discharge condition were GCS ≤14 and ISS >25. These data suggest that ISS alone is a poor marker for assessing undertriage in older patients. Additional parameters established in this study should be considered as potential markers for better predicting outcomes in older trauma patients.

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American Surgeon

Tập 87 Số 9

1412-1419

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