Accuracy of Prehospital Trauma Triage to Select Older Adults Requiring Urgent and Specialized Trauma Care.

INTRODUCTION

This study aims to assess the sensitivity and specificity of a 5-step prehospital trauma triage protocol to identify older adults who require urgent and specialized trauma care using different age cut-offs to define an older adult (≥55, ≥65, and ≥75 y old).

METHODS

Prehospital and in-hospital medical records were reviewed for injured patients transported by an ambulance to an emergency department (ED) between November 11, 2016 and March 3, 2017 in Quebec City, Canada. Sensitivities and specificities were calculated to assess the accuracy of our prehospital trauma triage protocol to identify patients who required at least one urgent in-hospital trauma intervention.

RESULTS

A total of 822 patients were included of which 62.9% were ≥55 y old and 56.3% were female. Fall (65.8%) was the main trauma mechanism. Seventy-six (9.2%) patients required urgent trauma care. This proportion was similar regardless of age (8.9%-9.5%). The proportion of patients who needed to be transported to the level-1 trauma center as per the triage protocol tended to decrease with increasing age (20.6% [whole cohort], 15.3% [≥55 y old], 11.4% [≥65 y old], and 9.0% [≥75 y old]). The sensitivity of the protocol for steps 1, 2, and 3 was 56.6% (whole cohort) and 30.0% for patients aged ≥75 y. The specificity ranged between 83.1% (whole cohort) and 93.1% (≥75 y old).

CONCLUSIONS

Our prehospital trauma triage protocol has insufficient sensitivity to identify patients with urgent trauma care needs, particularly in older adults.