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

Authors Fernandez FB, Ong A, Martin AP, Schwab CW, Wasser T, Butts CA, McNicholas AR, Muller AL, Barbera CF, Trupp R, Sigal AP

Received 18 April 2019

Accepted for publication 7 October 2019

Published 29 October 2019 Volume 2019:11 Pages 241—247

DOI https://doi.org/10.2147/OAEM.S212617

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Hans-Christoph Pape


Forrest B Fernandez,1 Adrian Ong,1 Anthony P Martin,1 C William Schwab,2 Tom Wasser,3 Christopher A Butts,4 Amanda R McNicholas,1 Alison L Muller,1 Charles F Barbera,5 Rachael Trupp,5 Adam P Sigal5

1Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA; 2Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; 3Complete Statistical Services, Macungie, PA, USA; 4Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA; 5Department of Emergency Medicine, Reading Hospital, Reading, PA, USA

Correspondence: Adam P Sigal
Department of Emergency Medicine, Reading Hospital, 6th Avenue and Spruce Street, P.O. Box 16052, West Reading, PA 19611, USA
Tel +1 484 628 3636
Email adam.sigal@towerhealth.org

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

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