Evaluating age in the field triage of injured persons

Yoko Nakamura, Mohamud Daya, Eileen M. Bulger, Martin Schreiber, Robert MacKersie, Renee Y. Hsia, N. Clay Mann, James F Holmes Jr, Kristan Staudenmayer, Zachary Sturges, Michael Liao, Jason Haukoos, Nathan Kuppermann, Erik D. Barton, Craig D. Newgard

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

We evaluate trauma undertriage by age group, the association between age and serious injury after accounting for other field triage criteria and confounders, and the potential effect of a mandatory age triage criterion for field triage. This was a retrospective cohort study of injured children and adults transported by 48 emergency medical services (EMS) agencies to 105 hospitals in 6 regions of the western United States from 2006 through 2008. We used probabilistic linkage to match EMS records to hospital records, including trauma registries, state discharge databases, and emergency department databases. The primary outcome measure was serious injury, as measured by an Injury Severity Score greater than or equal to 16. We assessed undertriage (Injury Severity Score <16 and triage-negative or transport to a nontrauma center) by age decile and used multivariable logistic regression models to estimate the association (linear and nonlinear) between age and Injury Severity Score greater than or equal to 16, adjusted for important confounders. We also evaluated the potential influence of age on triage efficiency and trauma center volume. Injured patients (260,027) were evaluated and transported by EMS during the 3-year study period. Undertriage increased for patients older than 60 years, reaching approximately 60% for those older than 90 years. There was a strong nonlinear association between age and Injury Severity Score greater than or equal to 16. For patients not meeting other triage criteria, the probability of serious injury was most notable after 60 years. A mandatory age triage criterion would have decreased undertriage at the expense of overtriage, with 1 patient with Injury Severity Score greater than or equal to 16 identified for every 60 to 65 additional patients transported to major trauma centers. Trauma undertriage increases in patients older than 60 years. Although the probability of serious injury increases among triage-negative patients with increasing age, the use of a mandatory age triage criterion appears inefficient for improving field triage.

Original languageEnglish (US)
Pages (from-to)335-345
Number of pages11
JournalAnnals of Emergency Medicine
Volume60
Issue number3
DOIs
StatePublished - Sep 2012

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Triage
Injury Severity Score
Wounds and Injuries
Emergency Medical Services
Trauma Centers
Logistic Models
Databases
Hospital Records
Medical Records
Registries
Hospital Emergency Service
Cohort Studies
Retrospective Studies
Age Groups
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Nakamura, Y., Daya, M., Bulger, E. M., Schreiber, M., MacKersie, R., Hsia, R. Y., ... Newgard, C. D. (2012). Evaluating age in the field triage of injured persons. Annals of Emergency Medicine, 60(3), 335-345. https://doi.org/10.1016/j.annemergmed.2012.04.006

Evaluating age in the field triage of injured persons. / Nakamura, Yoko; Daya, Mohamud; Bulger, Eileen M.; Schreiber, Martin; MacKersie, Robert; Hsia, Renee Y.; Mann, N. Clay; Holmes Jr, James F; Staudenmayer, Kristan; Sturges, Zachary; Liao, Michael; Haukoos, Jason; Kuppermann, Nathan; Barton, Erik D.; Newgard, Craig D.

In: Annals of Emergency Medicine, Vol. 60, No. 3, 09.2012, p. 335-345.

Research output: Contribution to journalArticle

Nakamura, Y, Daya, M, Bulger, EM, Schreiber, M, MacKersie, R, Hsia, RY, Mann, NC, Holmes Jr, JF, Staudenmayer, K, Sturges, Z, Liao, M, Haukoos, J, Kuppermann, N, Barton, ED & Newgard, CD 2012, 'Evaluating age in the field triage of injured persons', Annals of Emergency Medicine, vol. 60, no. 3, pp. 335-345. https://doi.org/10.1016/j.annemergmed.2012.04.006
Nakamura Y, Daya M, Bulger EM, Schreiber M, MacKersie R, Hsia RY et al. Evaluating age in the field triage of injured persons. Annals of Emergency Medicine. 2012 Sep;60(3):335-345. https://doi.org/10.1016/j.annemergmed.2012.04.006
Nakamura, Yoko ; Daya, Mohamud ; Bulger, Eileen M. ; Schreiber, Martin ; MacKersie, Robert ; Hsia, Renee Y. ; Mann, N. Clay ; Holmes Jr, James F ; Staudenmayer, Kristan ; Sturges, Zachary ; Liao, Michael ; Haukoos, Jason ; Kuppermann, Nathan ; Barton, Erik D. ; Newgard, Craig D. / Evaluating age in the field triage of injured persons. In: Annals of Emergency Medicine. 2012 ; Vol. 60, No. 3. pp. 335-345.
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