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Undertriage of the elderly major trauma patient continues in major trauma centre care: a retrospective cohort review: a retrospective cohort review

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Název: Undertriage of the elderly major trauma patient continues in major trauma centre care: a retrospective cohort review: a retrospective cohort review
Autoři: Antonia C Hoyle, Leela C Biant, Mike Young
Zdroj: Hoyle, A C, Biant, L C & Young, M 2020, 'Undertriage of the elderly major trauma patient continues in major trauma centre care : a retrospective cohort review', Emergency medicine journal : EMJ, vol. 37, no. 8, pp. 508-514. https://doi.org/10.1136/emermed-2019-208541
Informace o vydavateli: BMJ, 2020.
Rok vydání: 2020
Témata: Male, United Kingdom/epidemiology, United Kingdom, 3. Good health, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Trauma Centers, Triage/standards, Humans, Wounds and Injuries, Wounds and Injuries/classification, Female, Triage, Aged, Retrospective Studies
Popis: BackgroundMajor trauma (Injury Severity Score (ISS) ≥16) in older people is increasing, but concerns persist that major trauma is not always recognised in older patients on triage. This study compared undertriage of older and younger adult major trauma patients in the major trauma centre (MTC) setting to investigate this concern.MethodsA retrospective review of Trauma Audit and Research Network data was conducted for three MTCs in the UK for 3 months in 2014. Age, ISS, injury mechanism and injured areas were examined for all severely injured patients (ISS ≥16) and appropriate major trauma triage rates measured via the surrogate markers of trauma team activation and the presence of a consultant first attender, as per standards for major trauma care set by National Confidential Enquiry into Patient Outcomes and Deaths, Royal College of Surgeons of England and the British Orthopaedic Association. Trends in older (age ≥65) and younger (ages 18–64) adult major trauma presentation, triage and reception were reviewed.ResultsOf 153 severely injured patients, 46 were aged ≥65. Older patients were significantly less likely to receive the attention of a consultant first attender or trauma team. Similar trends were also seen on subgroup analysis by mechanism of injury or number of injured body areas. Older major trauma patients exhibit a higher mortality, despite a lower median ISS (older patient ISS=20 (IQR 16–25), younger patient ISS=25 (IQR 18–29)).ConclusionOlder major trauma patients are at greater risk of undertriage, even in the MTC environment. Existing hospital trauma triage practices should be further investigated to explain and reduce undertriage of elderly trauma patients.
Druh dokumentu: Article
Jazyk: English
ISSN: 1472-0213
1472-0205
DOI: 10.1136/emermed-2019-208541
Přístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/32546474
https://research.manchester.ac.uk/en/publications/d5e374b0-2624-4be6-87a6-61dfb86303bc
https://doi.org/10.1136/emermed-2019-208541
https://www.research.manchester.ac.uk/portal/en/publications/undertriage-of-the-elderly-major-trauma-patient-continues-in-major-trauma-centre-care(d5e374b0-2624-4be6-87a6-61dfb86303bc).html
https://www.ncbi.nlm.nih.gov/pubmed/32546474
https://emj.bmj.com/content/emermed/37/8/508.full.pdf
https://emj.bmj.com/content/early/2020/06/16/emermed-2019-208541
https://pubmed.ncbi.nlm.nih.gov/32546474/
https://emj.bmj.com/content/37/8/508
https://research.manchester.ac.uk/en/publications/d5e374b0-2624-4be6-87a6-61dfb86303bc
https://doi.org/10.1136/emermed-2019-208541
http://europepmc.org/abstract/med/32546474
Přístupové číslo: edsair.doi.dedup.....e32ee49349c4debd7b16c93fe607e67d
Databáze: OpenAIRE
Popis
Abstrakt:BackgroundMajor trauma (Injury Severity Score (ISS) ≥16) in older people is increasing, but concerns persist that major trauma is not always recognised in older patients on triage. This study compared undertriage of older and younger adult major trauma patients in the major trauma centre (MTC) setting to investigate this concern.MethodsA retrospective review of Trauma Audit and Research Network data was conducted for three MTCs in the UK for 3 months in 2014. Age, ISS, injury mechanism and injured areas were examined for all severely injured patients (ISS ≥16) and appropriate major trauma triage rates measured via the surrogate markers of trauma team activation and the presence of a consultant first attender, as per standards for major trauma care set by National Confidential Enquiry into Patient Outcomes and Deaths, Royal College of Surgeons of England and the British Orthopaedic Association. Trends in older (age ≥65) and younger (ages 18–64) adult major trauma presentation, triage and reception were reviewed.ResultsOf 153 severely injured patients, 46 were aged ≥65. Older patients were significantly less likely to receive the attention of a consultant first attender or trauma team. Similar trends were also seen on subgroup analysis by mechanism of injury or number of injured body areas. Older major trauma patients exhibit a higher mortality, despite a lower median ISS (older patient ISS=20 (IQR 16–25), younger patient ISS=25 (IQR 18–29)).ConclusionOlder major trauma patients are at greater risk of undertriage, even in the MTC environment. Existing hospital trauma triage practices should be further investigated to explain and reduce undertriage of elderly trauma patients.
ISSN:14720213
14720205
DOI:10.1136/emermed-2019-208541