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Trauma team activation criteria and outcomes of geriatric trauma: 10 year single centre cohort study

      Abstract

      Background

      With the aging population, the number of older patients with multiple injuries is increasing. The aim of this study was to understand the patterns and outcomes of older patients admitted to a major trauma centre in Hong Kong from 2006 to 2015, and investigate the performance of the trauma team activation (TTA) criteria for these elderly patients.

      Methods

      This was a retrospective cohort study from a university hospital major trauma centre in Hong Kong from 2006 to 2015. Patients aged 55 or above who entered the trauma registry were included. Patients were divided into those aged 55–70, and above 70. To test the performance of the TTA criteria, we defined injured patients with severe outcomes as those having any of the following: death within 30 days; the need for surgery; or the need for intensive care unit (ICU) care.

      Results

      2218 patients were included over the 10 year period. The 30-day mortality was 7.5% for aged 55–70 and 17.7% for those aged above 70. The sensitivity of TTA criteria for identifying severe outcomes for those aged 55 or above was 35.6%, with 91.6% specificity. The under-triage rate was 59% for age 55–70, and 69.1% for those aged above 70.

      Conclusion

      There is a need to consider alternative TTA criteria for our geriatric trauma population, and to more clearly define the process and standards of care in Hong Kong.

      Keywords

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      References

        • United Nations, Department of Economic and Social Affairs, Population Division
        World Population Ageing 2015 (ST/ESA/SER.A/390).
        (Available from:)
        • Hong Kong Special Administrative Region Government, Information Services Department
        Hong Kong Yearbook 2015.
        (Available from:)
        http://www.yearbook.gov.hk/2015/en/pdf/Facts.pdf
        Date: 2015
        Date accessed: October 30, 2017
        • Hong Kong Special Administrative Region Government, Information Services Department
        Hong Kong Yearbook 2006.
        (Available from:) ([Accessed 30th Oct 2017])
        • Hong Kong Special Administrative Region Government, Census and Statistics Department
        Hong Kong monthly digest of statistics September 2013: road traffic accident statistics in Hong Kong, 2003 to 2012.
        (Available from:)
        http://www.statistics.gov.hk/pub/B71309FC2013XXXXB0100.pdf
        Date: 2013
        Date accessed: October 30, 2017
        • Søreide K.
        • Krüger A.J.
        • Vårdal A.L.
        • Ellingsen C.L.
        • Søreide E.
        • Lossius H.M.
        Epidemiology and contemporary patterns of trauma deaths: changing place, similar pace, older face.
        World J Surg. 2007; 31: 2092-2103
        • Boyd C.R.
        • Tolson M.A.
        • Copes W.S.
        Evaluating trauma care: the TRISS method.
        J Trauma Acute Care Surg. 1987; 27: 370-378
        • The American College of Surgeons, Trauma Quality Improvement Program
        ACS TQIP geriatric trauma management guidelines.
        (Available from:)
        • Calland J.F.
        • Ingraham A.M.
        • Martin N.
        • Marshall G.T.
        • Schulman C.I.
        • Stapleton T.
        • Barraco R.D.
        Evaluation and management of geriatric trauma: an Eastern Association for the Surgery of Trauma practice management guideline.
        J Trauma Acute Care Surg. 2012; 73S345-50
        • National Health Service, London Operational Delivery Networks
        London major trauma system: management of elderly major trauma patients.
        (Available from:)
        • Kozar R.A.
        • Arbabi S.
        • Stein D.M.
        • Shackford S.R.
        • Barraco R.D.
        • Biffl W.L.
        • Brasel K.J.
        • Cooper Z.
        • Fakhry S.M.
        • Livingston D.
        • Moore F.
        Injury in the aged: geriatric trauma care at the crossroads.
        J Trauma Acute Care Surg. 2015; 78: 1197
        • Joseph B.
        • Pandit V.
        • Zangbar B.
        • Kulvatunyou N.
        • Hashmi A.
        • Green D.J.
        • O'Keeffe T.
        • Tang A.
        • Vercruysse G.
        • Fain M.J.
        • Friese R.S.
        Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis.
        JAMA Surg. 2014; 149: 766-772
        • Mcdonald V.S.
        • Thompson K.A.
        • Lewis P.R.
        • Sise C.B.
        • Sise M.J.
        • Shackford S.R.
        Frailty in trauma: a systematic review of the surgical literature for clinical assessment tools.
        J Trauma Acute Care Surg. 2016; 80: 824-834
        • Maxwell C.A.
        • Mion L.C.
        • Mukherjee K.
        • Dietrich M.S.
        • Minnick A.
        • May A.
        • Miller R.S.
        Feasibility of screening for preinjury frailty in hospitalized injured older adults.
        J Trauma Acute Care Surg. 2015; 78: 844-851
        • Maxwell C.A.
        • Mion L.C.
        • Mukherjee K.
        • Dietrich M.S.
        • Minnick A.
        • May A.
        • Miller R.S.
        Preinjury physical frailty and cognitive impairment among geriatric trauma patients determine postinjury functional recovery and survival.
        J Trauma Acute Care Surg. 2016; 80: 195-203
        • Joseph B.
        • Jokar T.O.
        • Hassan A.
        • Azim A.
        • Mohler M.J.
        • Kulvatunyou N.
        • Siddiqi S.
        • Phelan H.
        • Fain M.
        • Rhee P.
        Redefining the association between old age and poor outcomes after trauma: the impact of frailty syndrome.
        J Trauma Acute Care Surg. 2017; 82: 575-581
        • Goodmanson N.W.
        • Rosengart M.R.
        • Barnato A.E.
        • Sperry J.L.
        • Peitzman A.B.
        • Marshall G.T.
        Defining geriatric trauma: when does age make a difference?.
        Surgery. 2012; 152: 668-675
        • Hashmi A.
        • Ibrahim-Zada I.
        • Rhee P.
        • Aziz H.
        • Fain M.J.
        • Friese R.S.
        • Joseph B.
        Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis.
        J Trauma Acute Care Surg. 2014; 76: 894-901
        • Bergeron E.
        • Lavoie A.
        • Clas D.
        • Moore L.
        • Ratte S.
        • Tetreault S.
        • Lemaire J.
        • Martin M.
        Elderly trauma patients with rib fractures are at greater risk of death and pneumonia.
        J Trauma Acute Care Surg. 2003; 54: 478-485
        • Pieracci F.M.
        • Eachempati S.R.
        • Shou J.
        • Hydo L.J.
        • Barie P.S.
        Degree of anticoagulation, but not warfarin use itself, predicts adverse outcomes after traumatic brain injury in elderly trauma patients.
        J Trauma Acute Care Surg. 2007; 63: 525-530
        • Neideen T.
        • Lam M.
        • Brasel K.J.
        Preinjury beta blockers are associated with increased mortality in geriatric trauma patients.
        J Trauma Acute Care Surg. 2008; 65: 1016-1020
        • Bliuc D.
        • Nguyen N.D.
        • Milch V.E.
        • Nguyen T.V.
        • Eisman J.A.
        • Center J.R.
        Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women.
        JAMA. 2009; 301: 513-521
        • Demaria E.J.
        • Kenney P.R.
        • Merriam M.A.
        • Casanova L.A.
        • Gann D.S.
        Aggressive trauma care benefits the elderly.
        J Trauma Acute Care Surg. 1987; 27: 1200-1206
        • Demaria E.J.
        • Kenney P.R.
        • Merriam M.A.
        • Casanova L.A.
        • Gann D.S.
        Survival after trauma in geriatric patients.
        Ann Surg. 1987; 206: 738
        • Demetriades D.
        • Karaiskakis M.
        • Velmahos G.
        • Alo K.
        • Newton E.
        • Murray J.
        • Asensio J.
        • Belzberg H.
        • Berne T.
        • Shoemaker W.
        Effect on outcome of early intensive management of geriatric trauma patients.
        Br J Surg. 2002; 89: 1319-1322
        • Trunkey D.D.
        • Cahn R.M.
        • Lenfesty B.
        • Mullins R.
        Management of the geriatric trauma patient at risk of death: therapy withdrawal decision making.
        Arch Surg. 2000; 135: 34-38
        • Yeung J.H.
        • Chang A.L.
        • Ho W.
        • So F.L.
        • Graham C.A.
        • Cheng B.
        • Cheung N.K.
        • Ho H.F.
        • Yuen W.K.
        • Kam C.W.
        • Rainer T.H.
        High risk trauma in older adults in Hong Kong: a multicentre study.
        Injury. 2008; 39: 1034-1041
        • Cheng C.H.
        • Yim W.T.
        • Cheung N.K.
        • Yeung J.H.
        • Man C.Y.
        • Graham C.A.
        • Rainer T.H.
        Differences in injury pattern and mortality between Hong Kong elderly and younger patients.
        Hong Kong J Emerg Med. 2009; 16: 224-232
        • Lossius H.M.
        • Rehn M.
        • Tjosevik K.E.
        • Eken T.
        Calculating trauma triage precision: effects of different definitions of major trauma.
        J Trauma Manag Outcomes. 2012 Aug 17; 6: 9
        • Census and Statistics Department, Hong Kong SAR Government
        Demographic trends in Hong Kong 1986–2016.
        (Available from:)
        • Caterino J.M.
        • Valasek T.
        • Werman H.A.
        Identification of an age cutoff for increased mortality in patients with elderly trauma.
        Am J Emerg Med. 2010; 28: 151-158
        • Taylor M.D.
        • Tracy J.K.
        • Meyer W.
        • Pasquale M.
        • Napolitano L.M.
        Trauma in the elderly: intensive care unit resource use and outcome.
        J Trauma Acute Care Surg. 2002; 53: 407-414
        • Adams S.D.
        • Cotton B.A.
        • McGuire M.F.
        • Dipasupil E.
        • Podbielski J.M.
        • Zaharia A.
        • Ware D.N.
        • Gill B.S.
        • Albarado R.
        • Kozar R.A.
        • Duke J.R.
        The unique pattern of complications in elderly trauma patients at a Level I trauma center.
        J Trauma Acute Care Surg. 2012; 72
        • Lane P.
        • Sorondo B.
        • Kelly J.J.
        Geriatric trauma patients—are they receiving trauma center care?.
        Acad Emerg Med. 2003; 10: 244-250
        • Chang D.C.
        • Bass R.R.
        • Cornwell E.E.
        • MacKenzie E.J.
        Undertriage of elderly trauma patients to state-designated trauma centers.
        Arch Surg. 2008; 143: 776-781
        • Kodadek L.M.
        • Selvarajah S.
        • Velopulos C.G.
        • Haut E.R.
        • Haider A.H.
        Undertriage of older trauma patients: is this a national phenomenon?.
        J Surg Res. 2015; 199: 220-229
        • Staudenmayer K.L.
        • Hsia R.Y.
        • Mann N.C.
        • Spain D.A.
        • Newgard C.D.
        Triage of elderly trauma patients: a population-based perspective.
        J Am Coll Surg. 2013; 217: 569-576
        • Rainer T.H.
        • Cheung N.K.
        • Yeung J.H.
        • Graham C.A.
        Do trauma teams make a difference?: a single centre registry study.
        Resuscitation. 2007; 73: 374-381
        • Rehn M.
        • Eken T.
        • Krüger A.J.
        • Steen P.A.
        • Skaga N.O.
        • Lossius H.M.
        Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines.
        Scand J Trauma Resusc Emerg Med. 2009; 17: 1
        • Kohn M.A.
        • Hammel J.M.
        • Bretz S.W.
        • Stangby A.
        Trauma team activation criteria as predictors of patient disposition from the emergency department.
        Acad Emerg Med. 2004; 11: 1-9
        • Caterino J.M.
        • Raubenolt A.
        • Cudnik M.T.
        Modification of Glasgow Coma Scale criteria for injured elders.
        Acad Emerg Med. 2011; 18: 1014-1021
        • Newgard C.D.
        • Richardson D.
        • Holmes J.F.
        • Rea T.D.
        • Hsia R.Y.
        • Mann N.C.
        • Staudenmayer K.
        • Barton E.D.
        • Bulger E.M.
        • Haukoos J.S.
        • Western Emergency Services Translational Research Network (WESTRN) Investigators
        Physiologic field triage criteria for identifying seriously injured older adults.
        Prehosp Emerg Care. 2014; 18: 461-470
        • Ichwan B.
        • Darbha S.
        • Shah M.N.
        • Thompson L.
        • Evans D.C.
        • Boulger C.T.
        • Caterino J.M.
        Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults.
        Ann Emerg Med. 2015; 65: 92-100
        • Newgard C.D.
        • Holmes J.F.
        • Haukoos J.S.
        • Bulger E.M.
        • Staudenmayer K.
        • Wittwer L.
        • Stecker E.
        • Dai M.
        • Hsia R.Y.
        • Western Emergency Services Translational Research Network (WESTRN) Investigators
        Improving early identification of the high-risk elderly trauma patient by emergency medical services.
        Injury. 2016; 47: 19-25