Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria

Abstract

Background

Geriatric patients are at increased risk of injury following low-energy mechanisms and are less tolerant of injury. Current criteria for trauma team activation (TTA) often miss these injuries. We evaluated a novel triage process for an expedited Emergency Medicine Physician evaluation protocol (T3) for at-risk geriatric sub-populations not meeting trauma team activation (TTA) criteria.

Methods

Retrospective review of injured patients (≥65 years) from a Level II Trauma Center with an Injury Severity Score (ISS < 16), prior to (Pre-T3, Jan 2007-Oct 2009), and after (Post-T3, Jan 2010-Oct 2012), implementation of T3, as well as a contemporary period (CP, Jan 2013-Oct 2015). Demographics, physiologic variables, and timeliness of care were measured. Rates of ICU admission, operative procedures and lengths of stay and in-hospital mortality were compared for all periods. Logistic regression analysis determined variables independently associated with mortality.

Results

Post-T3, 49.2% of geriatric registry patients underwent T3 with a reduction in key time intervals. Median time to evaluation (42.1 mins vs 61.7 min, p<0.001), median time to CT (161.3 mins vs 212.9 mins, p<0.001) and EDLOS (364.6 mins vs 451.5 mins, p=0.023) were all reduced compared to non-expedited evaluations. There was no change in mortality after the implementation of the protocol.

Conclusion

The T3 protocol expedited patient evaluation of at-risk geriatric patients that would not otherwise meet TTA criteria. The new process met the goals of the American College of Surgeons Trauma Quality Improvement Program while conserving resources.

Keywords:

• trauma
• triage
• geriatrics

Acknowledgments

The authors express their gratitude to the multidisciplinary providers whose daily dedication has sustained the T3 program. Special thanks go to the RH trauma registrars who daily abstract the data critical to performance improvement of the Trauma Program. In addition, we would like to acknowledge the following individuals for their significant contributions to the study, Kristen Sandel MD, Sudan Butler MSN and Ryan Spinka BS.

Author Contributions

FBF, AO, CWS, ARM and CFB designed the study along with writing initial manuscript and edits. ARM and RT performed pilot chart review for design phase, had input into original manuscript and edits. APM extracted data for analysis. TW, APM, ALM and APS performed the statistical analysis and composition of Methods section along with input into original manuscript and design of the Tables. FBF, AO, APM, and TW interpreted the results. CFB and APS implemented the program in ED. FBF, AO, CFB, ARM, CAB, APS, CWS, ALM and APM all contributed to critical revisions of the final document. All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.