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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
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
Corresponding
E-mail address:

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.

Type
Original Research
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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