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The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan

Published online by Cambridge University Press:  13 September 2019

Matthew H. Meyers ,
Trent L. Wei ,
Julianne M. Cyr ,
Thomas M. Hunold ,
Frances S. Shofer ,
Christopher S. Cowden ,
Chailee F. Moss ,
Christopher E. Jensen ,
Timothy F. Platts-Mills  and
Jane H. Brice Open the ORCID record for Jane H. Brice [Opens in a new window]
Matthew H. Meyers
Affiliation:
Department of Internal Medicine, Vanderbilt University, Nashville, TennesseeUSA
Trent L. Wei
Affiliation:
Department of Internal Medicine, Duke University, Durham, North CarolinaUSA
Julianne M. Cyr
Affiliation:
Department of Emergency Medicine, University of North Carolina, Chapel Hill, North CarolinaUSA
Thomas M. Hunold
Affiliation:
School of Medicine, University of Virginia, Charlottesville, VirginiaUSA
Frances S. Shofer
Affiliation:
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaUSA
Christopher S. Cowden
Affiliation:
Department of Women’s Health, University of Texas at Austin, Austin, TexasUSA
Chailee F. Moss
Affiliation:
Department of Obstetrics and Gynecology, Johns Hopkins, Baltimore, MarylandUSA
Christopher E. Jensen
Affiliation:
Department of Internal Medicine, The Hospital of the University of Pennsylvania, Philadelphia, PennsylvaniaUSA
Timothy F. Platts-Mills
Affiliation:
Department of Emergency Medicine, University of North Carolina, Chapel Hill, North CarolinaUSA
Jane H. Brice*
Affiliation:
Department of Emergency Medicine, University of North Carolina, Chapel Hill, North CarolinaUSA
*
Correspondence: Jane H. Brice, MD, MPH Professor and Chair Department of Emergency Medicine University of North Carolina Chapel Hill, North Carolina 27599-7594 USA E-mail: [email protected]
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Abstract

Introduction:

In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.

Hypothesis/Problem:

The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.

Methods:

This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.

Results:

The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.

Conclusions:

State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.

Keywords

Emergency Medical Servicesgeriatrictransportation of patientstraumatriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 5 , October 2019 , pp. 497 - 505
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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References

Ortman, JM, Velkoff, VA, Hogan, H. An aging nation: the older population in the United States. Current Population Reports, P25-1140. US Census Bureau; Washington, DC: 2014.Google Scholar
Werman, HA, Erskine, T, Caterino, J, et al. Development of statewide geriatric patients’ trauma triage criteria. Prehosp Disaster Med. 2011;26(3):170–179.CrossRefGoogle Scholar
Lyman, S, Ferguson, SA, Braver, ER, et al. Older driver involvements in police reported crashes and fatal crashes: trends and projections. Inj Prev. 2002;8(2):116–120.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Fatalities and injuries from falls among older adults---United States, 1993--2003 and 2001--2005. MMWR: Morb Mortal Wkly Rep. 2006;55(45):1221–1224.Google Scholar
Spaite, DW, Criss, EA, Valenzuela, TD, et al. Geriatric injury: an analysis of prehospital demographics, mechanisms, and patterns. Ann Emerg Med. 1990;19(12):1418–1421.CrossRefGoogle ScholarPubMed
Chu, I, Vaca, F, Stratton, S, et al. Geriatric trauma care: challenges facing emergency medical services. Cal J Emerg Med. 2007;8(2):51–55.Google ScholarPubMed
Sammy, I, Lecky, F, Sutton, A, et al. Factors affecting mortality in older trauma patients-a systematic review and meta-analysis. Injury. 2016;47(6):1170–1183.CrossRefGoogle ScholarPubMed
Hashmi, A, Ibrahim-Zada, I, Rhee, P, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014; 76:894–901.CrossRefGoogle ScholarPubMed
Sharma, BR. Triage in trauma-care system: a forensic view. J Clin Forensic Med. 2005;12(2):64–73.CrossRefGoogle ScholarPubMed
Meldon, SW, Reilly, M, Drew, BL, et al. Trauma in the very elderly: a community-based study of outcomes at trauma and non-trauma centers. Acad Emerg Med. 2000;7(10):1166.Google ScholarPubMed
Chang, DC, Bass, RR, Cornwell, EE, et al. Under-triage of elderly trauma patients to state-designated trauma centers. Arch Surg. 2008;143(8):776–781.CrossRefGoogle Scholar
Nakamura, Y, Daya, M, Bulger, EM, et al. Evaluating age in the field triage of injured persons. Ann Emerg Med. 2012;60(3):335–345.CrossRefGoogle ScholarPubMed
Cox, S, Morrison, C, Cameron, P, Smith, K. Advancing age and trauma: triage destination compliance and mortality in Victoria, Australia. Injury. 2014;45(9):1312–1319.CrossRefGoogle ScholarPubMed
Sasser, SM, Hunt, RC, Faul, M, et al; National Expert Panel on Field Triage, Centers for Disease Control and Prevention (CDC). Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61(RR01):1–20.Google Scholar
Ichwan, B, Darbha, S, Shah, MN, et al. Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults. Ann Emerg Med. 2015;65(1):92–100.CrossRefGoogle ScholarPubMed
Caterino, JM, Brown, NV, Hamilton, MW, et al. Effect of geriatric-specific trauma triage criteria on outcomes in injured older adults: a statewide retrospective cohort study. J Am Geriatr Soc. 2016;64(10):1944–1951.CrossRefGoogle ScholarPubMed
MacKenzie, EJ, Rivara, FP, Jurkovich, GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–378.CrossRefGoogle ScholarPubMed
The North Carolina Office of EMS. NC EMS Triage and Destination Plans. http://www.ncems.org/triageanddestination.html. Accessed January 29, 2019.Google Scholar
Moss, C, Cowden, CS, Atterton, LM, et al. Accuracy of EMS trauma transport destination plans in North Carolina. Prehosp Emerg Care. 2015;19(1):53–60.CrossRefGoogle ScholarPubMed
Brice, JH, Shofer, FS, Cowden, C, et al. Evaluation of the implementation of the Trauma Triage and Destination Plan on the field triage of injured patients in North Carolina. Prehosp Emerg Care. 2017;21(5):591–604.CrossRefGoogle ScholarPubMed
US Census Bureau QuickFacts: North Carolina. http://www.census.gov/quickfacts/table/PST045215/37. Accessed January 29, 2019.Google Scholar
NEMSIS. NEMSIS version 2.2.1 data dictionary. https://nemsis.org/technical-resources/version-2/version-2-dataset-dictionaries/. Accessed January 29, 2019.Google Scholar
Mears, GD, Pratt, D, Glickman, SW, et al. The North Carolina EMS Data System: a comprehensive integrated emergency medical services quality improvement program. Prehosp Emerg Care. 2010;14(1):85–94.CrossRefGoogle ScholarPubMed
Rotondo, MF, Cribari, C, Smith, RS. Chapter 3; Prehospital Trauma Care in Resources for Optimal Care of the Injured Patient. Chicago, Illinois USA: American College of Surgeons; 2014.Google Scholar
Gage, AM, Traven, N, Rivara, FP, et al. Compliance with Centers for Disease Control and Prevention field triage guidelines in an established trauma system. J Amer Coll Surg. 2012;215(1):148–154.CrossRefGoogle Scholar
Báez, AA, Lane, PL, Sorondo, B. System compliance with out-of-hospital trauma triage criteria. J Trauma. 2003;54(2):344–351.Google ScholarPubMed
Ma, MH, MacKenzie, EJ, Alcorta, R, et al. Compliance with prehospital triage protocols for major trauma patients. J Trauma. 1999;46(1):168–175.Google ScholarPubMed
Esposito, TJ, Offner, PJ, Jurkovich, GJ, et al. Do prehospital trauma center triage criteria identify major trauma victims? Arch Surg. 1995;130(2):171–176.CrossRefGoogle ScholarPubMed
Henry, MC, Hollander, JE, Alicandro, JM, et al. Incremental benefit of individual American College of Surgeons trauma triage criteria. Acad Emerg Med. 1996;3(11):992–1000.CrossRefGoogle ScholarPubMed
Jones, CM, Cushman, JT, Lerner, EB, et al. Prehospital trauma triage decision-making: a model of what happens between the 9-1-1 call and the hospital. Prehosp Emerg Care. 2016;20(1):6–14.CrossRefGoogle ScholarPubMed
Brown, LH, Hubble, MW, Cone, DC, et al. Paramedic determinations of medical necessity: a meta-analysis. Prehosp Emerg Care. 2009;13(4):516–527.CrossRefGoogle ScholarPubMed
Platts-Mills, TF, Evans, CS, Brice, JH. Prehospital triage of injured older adults: thinking slow inside the golden hour. J Amer Geriatr Soc. 2016;64(10):1941–1943.CrossRefGoogle ScholarPubMed
Brown, JB, Rosengart, MR, Billiar, TR, Peitzman, AB, et al. Distance matters: effect of geographic trauma system resource organization on fatal motor vehicle collisions. J Trauma Acute Care Surg. 2017;83(1):111–118.CrossRefGoogle ScholarPubMed
Jarman, MP, Curriero, FC, Haut, ER, et al. Associations of distance to trauma care, community income, and neighborhood median age with rates of injury mortality. JAMA Surg. 2018;153(6):535–543.CrossRefGoogle ScholarPubMed