PMID- 29685471
OWN - NLM
STAT- MEDLINE
DCOM- 20190107
LR  - 20190107
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 55
IP  - 2
DP  - 2018 Aug
TI  - The Age of Undertriage: Current Trauma Triage Criteria Underestimate The Role of 
      Age and Comorbidities in Early Mortality.
PG  - 278-287
LID - S0736-4679(18)30110-0 [pii]
LID - 10.1016/j.jemermed.2018.02.001 [doi]
AB  - BACKGROUND: National guidelines recommend that prehospital and emergency
      department (ED) criteria identify patients who might benefit from trauma center
      triage and highest-level trauma team activation. However, some patients who are
      seemingly "stable" in the field and do not meet the standard criteria for trauma 
      activation still die. OBJECTIVES: The purpose of this study was to identify these
      at-risk patients to potentially improve triage algorithms. METHODS: Patients
      enrolled in the National Trauma Data Bank (2007-2012) were included. All adult
      blunt trauma patients that were stable in the field and upon arrival to the ED
      (defined as a Glasgow Coma Scale score of 13-15, a heart rate </=120 beats/min,
      systolic blood pressure >/=90 mm Hg, and diastolic blood pressure </=200 mm Hg)
      and did not meet the standard criteria for the highest-level trauma team
      activation as defined by the American College of Surgeons were included.
      Demographic, clinical, and injury data including comorbidities, ED vitals, and
      outcome were collected. Regression models were used to identify independent risk 
      factors for mortality. RESULTS: A total of 1,003,350 patients were stable in both
      the field and ED. Of these 11,010 (1.1%) died, including 1785 (0.2%) who died
      within 24 hours of hospital admission. The mortality in patients >/=60 years of
      age was 2.6%, and in patients >/=60 years of age with either a cerebrovascular
      accident (CVA) or congestive heart failure (CHF) was 5.4%. Age >/=60 years was a 
      significant independent predictor of early mortality (odds ratio [OR] 4.53, p <
      0.001). CHF (OR 1.88, p < 0.001) and a history of stroke (OR 1.52, p < 0.001)
      were also significant independent predictors of mortality. CONCLUSIONS: Despite
      apparent evidence of both prehospital stability and stability upon arrival to the
      ED, patients >/=60 years of age and with a history of CHF or CVA have a
      significantly increased risk of early mortality after blunt trauma. These
      patients are at risk for subsequent clinical deterioration and should be
      considered for early transfer to a trauma center with highest-level activation.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Benjamin, Elizabeth R
AU  - Benjamin ER
AD  - Division of Trauma and Acute Care Surgery, Department of Surgery, LAC+USC Medical
      Center, Los Angeles, California.
FAU - Khor, Desmond
AU  - Khor D
AD  - Division of Trauma and Acute Care Surgery, Department of Surgery, LAC+USC Medical
      Center, Los Angeles, California.
FAU - Cho, Jayun
AU  - Cho J
AD  - Division of Trauma and Acute Care Surgery, Department of Surgery, LAC+USC Medical
      Center, Los Angeles, California.
FAU - Biswas, Subarna
AU  - Biswas S
AD  - Division of Trauma and Acute Care Surgery, Department of Surgery, LAC+USC Medical
      Center, Los Angeles, California.
FAU - Inaba, Kenji
AU  - Inaba K
AD  - Division of Trauma and Acute Care Surgery, Department of Surgery, LAC+USC Medical
      Center, Los Angeles, California.
FAU - Demetriades, Demetrios
AU  - Demetriades D
AD  - Division of Trauma and Acute Care Surgery, Department of Surgery, LAC+USC Medical
      Center, Los Angeles, California.
LA  - eng
PT  - Journal Article
DEP - 20180420
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Comorbidity/trends
MH  - Emergency Service, Hospital/organization & administration
MH  - Female
MH  - Glasgow Coma Scale
MH  - Guidelines as Topic/*standards
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Risk Factors
MH  - Trauma Centers/organization & administration/statistics & numerical data
MH  - Triage/methods/*standards
OTO - NOTNLM
OT  - *age
OT  - *comorbidities
OT  - *trauma
OT  - *undertriage
EDAT- 2018/04/25 06:00
MHDA- 2019/01/08 06:00
CRDT- 2018/04/25 06:00
PHST- 2017/04/29 00:00 [received]
PHST- 2018/02/04 00:00 [revised]
PHST- 2018/02/06 00:00 [accepted]
PHST- 2018/04/25 06:00 [pubmed]
PHST- 2019/01/08 06:00 [medline]
PHST- 2018/04/25 06:00 [entrez]
AID - S0736-4679(18)30110-0 [pii]
AID - 10.1016/j.jemermed.2018.02.001 [doi]
PST - ppublish
SO  - J Emerg Med. 2018 Aug;55(2):278-287. doi: 10.1016/j.jemermed.2018.02.001. Epub
      2018 Apr 20.