The Age of Undertriage: Current Trauma Triage Criteria Underestimate The Role of Age and Comorbidities in Early Mortality

摘要

BackgroundNational guidelines recommend that prehospital and emergency department (ED) criteria identify patients who might benefit from trauma center triage and highest-level trauma team activation. However, some patients who are seemingly “stable” in the field and do not meet the standard criteria for trauma activation still die. ObjectivesThe purpose of this study was to identify these at-risk patients to potentially improve triage algorithms. MethodsPatients enrolled in the National Trauma Data Bank (2007–2012) were included. All adult blunt trauma patients that were stable in the field and upon arrival to the ED (defined as a Glasgow Coma Scale score of 13–15, a heart rate ≤120 beats/min, systolic blood pressure ≥90?mm Hg, and diastolic blood pressure ≤200?mm Hg) and did not meet the standard criteria for the highest-level trauma team activation as defined by the American College of Surgeons were included. Demographic, clinical, and injury data including comorbidities, ED vitals, and outcome were collected. Regression models were used to identify independent risk factors for mortality. ResultsA total of 1,003,350 patients were stable in both the field and ED. Of these 11,010 (1.1%) died, including 1785 (0.2%) who died within 24?hours of hospital admission. The mortality in patients ≥60?years of age was 2.6%, and in patients ≥60?years of age with either a cerebrovascular accident (CVA) or congestive heart failure (CHF) was 5.4%. Age ≥60?years was a significant independent predictor of early mortality (odds ratio [OR] 4.53,p?