Geriatric patients on antithrombotic therapy as a criterion for trauma team activation leads to over triage

• Published in: The American journal of surgery Vol. 219; no. 1; pp. 43 - 48
• Main Authors: Callahan, Zachary M., Gadomski, Stephen P., Koganti, Deepika, Patel, Pankaj H., Beekley, Alec C., Williams, Patricia, Donnelly, Julie, Cohen, Murray J., Marks, Joshua A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2020; Elsevier Limited
• Subjects: Activation; Age; Aged; Aged, 80 and over; Anticoagulation; Antithrombotic; Blood banks; Coma; Criteria; Demographics; Demography; Emergency medical services; Female; Fibrinolytic Agents - therapeutic use; Geriatric Assessment; Geriatric trauma; Geriatrics; Head injuries; Hemorrhage; Humans; Intensive care; Male; Mortality; Nursing; Overtriage; Patients; Retrospective Studies; Statistical analysis; Trauma; Triage; Triage - standards; Triage - statistics & numerical data; Undertriage; Wounds and Injuries - therapy; Triage; Anticoagulation; Overtriage; Undertriage; Geriatric trauma; Antithrombotic
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.04.011

Our institution amended its trauma activation criteria to require a Level II activation for patients ≥65 years old on antithrombotic medication presenting with suspected head trauma.
Our institutional trauma registry was queried for geriatric patients on antithrombotic medication in the year before and after this criteria change. Demographics, presentation metrics, level of activation, and outcomes were compared between groups.
After policy change, a greater proportion of patients received a trauma activation (19.9 vs. 74.9%, P < 0.001) and a greater proportion of these patients were discharged directly home without injury (4.3 vs. 44%, P < 0.001). However, a smaller proportion of patients with a critical Emergency Department disposition or traumatic intracranial hemorrhage failed to receive a trauma activation (65.1 vs. 23.5%, P < 0.001; 70.7% vs. 27.3%, P < 0.001). There was no change in mortality (4.3 vs. 2.0%, P = 0.21).
Implementing new criteria increased overtriage, decreased undertriage, and had little effect on mortality.
•Liberalizing trauma activation criteria increased the rate of activations.•Policy change increased overtriage and decreased undertriage.•No change in mortality was noted.
Our trauma center instituted a policy change that required a trauma team activation for all patients 65 years or older, taking antiplatelet or anticoagulant therapy, presenting with suspected head trauma. This change drastically increased the number of trauma team activations, increased the rate of overtriage, decreased the rate of undertriage, and had little effect on mortality.