The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan

Matthew H. Meyers, Trent L. Wei, Julianne M. Cyr, Thomas M. Hunold, Frances S. Shofer, Christopher S. Cowden, Chailee Moss, Christopher E. Jensen, Timothy F. Platts-Mills, Jane H. Brice

Research output: Contribution to journalArticle

Abstract

Introduction:In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.Hypothesis/Problem:The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.Methods:This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP's physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.Results:The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- A nd post-TTDP: Systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- A nd post-TTDP periods.Conclusions:State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalPrehospital and disaster medicine
DOIs
StateAccepted/In press - Jan 1 2019

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Triage
Wounds and Injuries
Trauma Centers
Emergency Medical Services
Geriatrics
Guidelines
Blood Pressure
Coma
Information Systems

Keywords

  • Emergency Medical Services
  • geriatric
  • Keywords:
  • transportation of patients
  • trauma
  • triage

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Meyers, M. H., Wei, T. L., Cyr, J. M., Hunold, T. M., Shofer, F. S., Cowden, C. S., ... Brice, J. H. (Accepted/In press). The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan. Prehospital and disaster medicine, 1-9. https://doi.org/10.1017/S1049023X19004825

The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan. / Meyers, Matthew H.; Wei, Trent L.; Cyr, Julianne M.; Hunold, Thomas M.; Shofer, Frances S.; Cowden, Christopher S.; Moss, Chailee; Jensen, Christopher E.; Platts-Mills, Timothy F.; Brice, Jane H.

In: Prehospital and disaster medicine, 01.01.2019, p. 1-9.

Research output: Contribution to journalArticle

Meyers, MH, Wei, TL, Cyr, JM, Hunold, TM, Shofer, FS, Cowden, CS, Moss, C, Jensen, CE, Platts-Mills, TF & Brice, JH 2019, 'The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan', Prehospital and disaster medicine, pp. 1-9. https://doi.org/10.1017/S1049023X19004825
Meyers, Matthew H. ; Wei, Trent L. ; Cyr, Julianne M. ; Hunold, Thomas M. ; Shofer, Frances S. ; Cowden, Christopher S. ; Moss, Chailee ; Jensen, Christopher E. ; Platts-Mills, Timothy F. ; Brice, Jane H. / The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan. In: Prehospital and disaster medicine. 2019 ; pp. 1-9.
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title = "The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan",
abstract = "Introduction:In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.Hypothesis/Problem:The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.Methods:This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP's physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.Results:The proportion of patients transported to a trauma center pre-TTDP (24.4{\%} [95{\%} CI 22.7{\%}-26.1{\%}]; n = 604) was similar to the proportion post-TTDP (24.4{\%} [95{\%} CI 22.9{\%}-26.0{\%}]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- A nd post-TTDP: Systolic blood pressure <90 mmHg (22.5{\%} versus 23.5{\%}); respiratory rate <10 or >29 (23.2{\%} versus 22.6{\%}); and Glascow Coma Scale (GCS) score <13 (26.0{\%} versus 26.4{\%}). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- A nd post-TTDP periods.Conclusions:State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.",
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author = "Meyers, {Matthew H.} and Wei, {Trent L.} and Cyr, {Julianne M.} and Hunold, {Thomas M.} and Shofer, {Frances S.} and Cowden, {Christopher S.} and Chailee Moss and Jensen, {Christopher E.} and Platts-Mills, {Timothy F.} and Brice, {Jane H.}",
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T1 - The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan

AU - Meyers, Matthew H.

AU - Wei, Trent L.

AU - Cyr, Julianne M.

AU - Hunold, Thomas M.

AU - Shofer, Frances S.

AU - Cowden, Christopher S.

AU - Moss, Chailee

AU - Jensen, Christopher E.

AU - Platts-Mills, Timothy F.

AU - Brice, Jane H.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction:In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.Hypothesis/Problem:The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.Methods:This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP's physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.Results:The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- A nd post-TTDP: Systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- A nd post-TTDP periods.Conclusions:State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.

AB - Introduction:In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.Hypothesis/Problem:The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.Methods:This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP's physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.Results:The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- A nd post-TTDP: Systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- A nd post-TTDP periods.Conclusions:State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.

KW - Emergency Medical Services

KW - geriatric

KW - Keywords:

KW - transportation of patients

KW - trauma

KW - triage

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