Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, LE1 7HA, UK.
Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Eur Geriatr Med. 2021 Oct;12(5):903-919. doi: 10.1007/s41999-021-00512-5. Epub 2021 Jun 10.
It is argued that many older trauma patients are under-triaged in prehospital care which may adversely affect their outcomes. This systematic review aimed to assess prehospital under-triage rates for older trauma patients, the accuracy of the triage criteria, and the impact of prehospital triage decisions on outcomes.
A computerised literature search using MEDLINE, Scopus, and CINHAL databases was conducted for studies published between 1966 and 2021 using a list of predetermined index terms and their associated alternatives. Studies which met the inclusion criteria were included and critiqued using the Critical Appraisal Skills Programme tool. Due to the heterogeneity of the included studies, narrative synthesis was used in this systematic review.
Of the 280 identified studies, 23 met the inclusion criteria. Current trauma triage guidelines have poor sensitivity to identify major trauma and the need for TC care for older adults. Although modified triage tools for this population have improved sensitivity, they showed significantly decreased specificity or were not applied to all older people. The issue of low rates of TC transport for positively triaged older patients is not well understood. Furthermore, the benefits of TC treatment for older patients remain uncertain.
This systematic review showed that under-triage is an ongoing issue for older trauma patients in prehospital care and its impact on their outcomes is still uncertain. Further high-quality prospective research is needed to assess the accuracy of prehospital triage criteria, the factors other than the triage criteria that affect transport decisions, and the impact of under-triage on outcomes.
有人认为，许多老年创伤患者在院前护理中分诊不足，这可能对他们的结局产生不利影响。本系统评价旨在评估老年创伤患者的院前分诊不足率、分诊标准的准确性，以及院前分诊决策对结局的影响。
使用 MEDLINE、Scopus 和 CINHAL 数据库，使用预定的索引术语列表及其相关变体，对 1966 年至 2021 年间发表的研究进行计算机文献检索。纳入符合纳入标准的研究，并使用批判性评估技能计划工具进行评估。由于纳入研究的异质性，本系统评价采用叙述性综合方法。
在 280 项已确定的研究中，有 23 项符合纳入标准。目前的创伤分诊指南对识别老年人的严重创伤和需要 TC 护理的敏感性较差。尽管针对该人群的改良分诊工具提高了敏感性，但特异性显著降低或未应用于所有老年人。对于分诊阳性的老年患者，TC 转运率低的问题尚未得到很好的理解。此外，TC 治疗对老年患者的益处仍不确定。
本系统评价表明，在院前护理中，老年创伤患者分诊不足仍然是一个持续存在的问题，其对结局的影响仍不确定。需要进一步开展高质量的前瞻性研究，以评估院前分诊标准的准确性、影响转运决策的除分诊标准以外的因素，以及分诊不足对结局的影响。
