Abstract 158: Matching Trauma Triage Criteria to Adult Age: Development of Field Triage Guidelines for Identifying High-Risk Young and Older Adults
Introduction: There are adult age-based differences in trauma center benefit and triage rule sensitivity.
Hypothesis: Redeveloped age-specific adult triage criteria will better identify high-risk young and older adults compared to the American College of Surgeons Committee on Trauma (ACSCOT) criteria.
Methods: This was a population-based, retrospective cohort study of injured young (18–54 years) and older (>=55 years) adults evaluated by 42 EMS agencies transporting to 4 trauma centers and 40 community hospitals in 2 Northwest US regions over 3 years (2006–08). All patients with an EMS provider “primary impression” of injury or trauma were included, regardless of field transport or outcome. Field variables included the 25 ACSCOT trauma triage criteria, SBP, GCS, respirations, heart rate, age, gender, and mechanism of injury. The primary outcome was serious injury (Abbreviated Injury Scale score >= 3) or major non-orthopedic surgery. We used 75% of the sample to derive the rule with classification and regression tree analysis, and the remaining 25% for validation.
Results: EMS personnel evaluated 92,035 young and 62,747 older injured adults, of whom 15.6% and 23.5% had serious injury/surgery. Among young adults, the decision rule included: EMS provider judgment, GCS <= 14, ventilation assistance, mechanism (penetrating injury, high energy, fall, pedestrian vs. auto, concerning MVC, electrocution, machinery, or environmental) or abnormal history/physical exam (comorbidity, pelvic fracture, amputation, paralysis, SBP < 100, heart rate < 80). The rule for older adults was similar, but included GCS<= 12 and fewer criteria. For young adults, sensitivity and specificity were 81.2% (95%CI 78.3–84.1%) and 31.2% (95%CI 28.7–33.6%) versus 35.5% and 90.4% with ACSCOT criteria. For older adults, sensitivity and specificity were 90.4% (95%CI 85.1–95.6%) and 17.7% (95%CI 10.6–24.9%) compared to 21.7% and 93.2% with ACSCOT. The new criteria would require 22,709 adults re-routed to trauma centers annually.
Conclusions: The revised adult triage guidelines are simpler and demonstrate notably higher sensitivity than ACSCOT criteria, particularly for older adults, yet would require large shifts in the number of patients transported to trauma centers.
- © 2010 by American Heart Association, Inc.