Alshibani Abdullah, Banerjee Jay, Lecky Fiona, Coats Timothy J, Alharbi Meshal, Conroy Simon
Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK.
Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Open Access Emerg Med. 2021 Mar 26;13:117-135. doi: 10.2147/OAEM.S297850. eCollection 2021.
Caring for older people is an important part of prehospital practice, including appropriate triage and transportation decisions. However, prehospital triage criteria are designed to predominantly assess injury severity or high-energy mechanism which is not the case for older people who often have injuries compounded by multimorbidity and frailty. This has led to high rates of under-triage in this population. This narrative review aimed to assess aspects other than triage criteria to better understand and improve prehospital triage decisions for older trauma patients. This includes integrating frailty assessment in prehospital trauma triage, which was shown to predict adverse outcomes for older trauma patients. Furthermore, determining appropriate outcome measures and the benefits of Major Trauma Centers (MTCs) for older trauma patients should be considered in order to direct accurate and more beneficial prehospital trauma triage decisions. It is still not clear what are the appropriate outcome measures that should be applied when caring for older trauma patients. There is also no strong consensus about the benefits of MTC access for older trauma patients with regards to survival, in-hospital length of stay, discharge disposition, and complications. Moreover, looking into factors other than triage criteria such as distance to MTCs, patient or relative choice, training, unfamiliarity with protocols, and possible ageism, which were shown to impact prehospital triage decisions but their impact on outcomes has not been investigated yet, should be more actively assessed and investigated for this population. Therefore, this paper aimed to discuss the available evidence around frailty assessment in prehospital care, appropriate outcome measures for older trauma patients, the benefits of MTC access for older patients, and factors other than triage criteria that could adversely impact accurate prehospital triage decisions for older trauma patients. It also provided several suggestions for the future.
照顾老年人是院前医疗实践的重要组成部分，包括进行适当的分诊和转运决策。然而，院前分诊标准主要旨在评估损伤严重程度或高能量机制，而对于经常因多种疾病和身体虚弱而使损伤情况更为复杂的老年人来说并非如此。这导致了该人群中低分诊率居高不下。本叙述性综述旨在评估分诊标准以外的其他方面，以便更好地理解和改进老年创伤患者的院前分诊决策。这包括将身体虚弱评估纳入院前创伤分诊，研究表明这可以预测老年创伤患者的不良预后。此外，应考虑确定适当的预后指标以及大型创伤中心（MTC）对老年创伤患者的益处，以便做出准确且更有益的院前创伤分诊决策。目前仍不清楚在照顾老年创伤患者时应采用哪些适当的预后指标。对于老年创伤患者进入MTC在生存、住院时间、出院处置和并发症方面的益处，也没有形成强烈共识。此外，应更积极地评估和研究除分诊标准以外的其他因素，如到MTC的距离、患者或家属的选择、培训、对方案不熟悉以及可能存在的年龄歧视等，这些因素已被证明会影响院前分诊决策，但它们对预后的影响尚未得到研究。因此，本文旨在讨论院前护理中身体虚弱评估的现有证据、老年创伤患者的适当预后指标、老年患者进入MTC的益处以及可能对老年创伤患者准确的院前分诊决策产生不利影响的分诊标准以外的因素。本文还提出了一些未来的建议。
