Geriatric-Specific Triage Criteria Are More Sensitive Than Standard Adult Criteria in Identifying Need for Trauma Center Care in Injured Older Adults

• Published in: Annals of emergency medicine Vol. 65; no. 1; pp. 92 - 100.e3
• Main Authors: Ichwan, Brian, BS, Darbha, Subrahmanyam, MS, Shah, Manish N., MD, MPH, Thompson, Laura, MD, MPH, Evans, David C., MD, Boulger, Creagh T., MD, Caterino, Jeffrey M., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States 01-01-2015
• Subjects: Adolescent; Adult; Age Factors; Aged; Emergency; Female; Geriatric Assessment - methods; Humans; Injury Severity Score; Male; Middle Aged; Practice Guidelines as Topic; Retrospective Studies; Sensitivity and Specificity; Trauma Centers - statistics & numerical data; Triage - standards; Wounds and Injuries - classification; Wounds and Injuries - diagnosis; Young Adult
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2014.04.019

Study objective We evaluate the sensitivity of Ohio's 2009 emergency medical services (EMS) geriatric trauma triage criteria compared with the previous adult triage criteria in identifying need for trauma center care among older adults. Methods We studied a retrospective cohort of injured patients aged 16 years or older in the 2006 to 2011 Ohio Trauma Registry. Patients aged 70 years or older were considered geriatric. We identified whether each patient met the geriatric and the adult triage criteria. The outcome measure was need for trauma center care, defined by surrogate markers: Injury Severity Score greater than 15, operating room in fewer than 48 hours, any ICU stay, and inhospital mortality. We calculated sensitivity and specificity of both triage criteria for both age groups. Results We included 101,577 patients; 33,379 (33%) were geriatric. Overall, 57% of patients met adult criteria and 68% met geriatric criteria. Using Injury Severity Score, for older adults geriatric criteria were more sensitive for need for trauma center care (93%; 95% confidence interval [CI] 92% to 93%) than adult criteria (61%; 95% CI 60% to 62%). Geriatric criteria decreased specificity in older adults from 61% (95% CI 61% to 62%) to 49% (95% CI 48% to 49%). Geriatric criteria in older adults (93% sensitivity, 49% specificity) performed similarly to the adult criteria in younger adults (sensitivity 87% and specificity 44%). Similar patterns were observed for other outcomes. Conclusion Standard adult EMS triage guidelines provide poor sensitivity in older adults. Ohio's geriatric trauma triage guidelines significantly improve sensitivity in identifying Injury Severity Score and other surrogate markers of the need for trauma center care, with modest decreases in specificity for older adults.