| Learning Objective #1: Describe the outcomes of over triage and under triage of adult trauma patients | |||
| Learning Objective #2: Identify issues associated with prehospital trauma triage |
Introduction: Undertriage of older trauma victims has been a persistent and serious problem. Due to physiological changes and pre-existing disease, blunt trauma in older persons is often covert. Prehospital trauma triage guidelines developed for use with a general adult population may not be sensitive enough to detect covert injuries in elderly trauma patients. This study examined the sensitivity and specificity of one state's prehospital trauma triage guidelines for adults with a particular focus on the triage of elderly persons. Methods: This retrospective study used patient discharge data to examine the sensitivity (a measure of undertriage) and specificity (a measure of overtriage) of the adult prehospital trauma triage guidelines in three counties with Level 1 trauma centers. Sensitivity and specificity of young-middle age adults was compared to that of older adults. Results: Undertriage for young-middle age males was 8%, while the undertriage of young-middle age females was 12%, followed by an undertriage rate of 18% for older males and 15% for older females. Overtriage was present in all age groups, indicating that many motor vehicle crash victims who were admitted to trauma centers could have been admitted to non-trauma center hospitals. Discussion: Low sensitivity and specificity of trauma triage guidelines results in undertriage and overtriage. These guidelines should include age as a decision point to avoid placing older persons at risk for undertriage. While some degree of overtriage is unavoidable without increasing undertriage, efforts should be made to minimize this costly occurrence.
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