ArticleThe journal of trauma and acute care surgery2019
Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults.
Article in The journal of trauma and acute care surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 5 of them syntheses that pooled it.
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Who cites it
19 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Substantial heterogeneity in trauma triage tool characteristic operationalization for identification of major trauma: a hybrid systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Mechanism of injury and special considerations as predictive of serious injury: A systematic review.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2022Pooled it
- National guideline for the field triage of injured patients: Recommendations of the National Expert Panel on Field Triage, 2021.The journal of trauma and acute care surgery · 2022Guideline
- Under-triage of older trauma patients in prehospital care: a systematic review.European geriatric medicine · 2021Pooled it
- Evaluation of elderly specific pre-hospital trauma triage criteria: a systematic review.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Pooled it
- Evaluating performance and potential clinical benefit of the Swedish On Scene Injury Severity Prediction (OSISP) model for prehospital field triage on Norwegian trauma data.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- Article
- Criteria for the qualification of geriatric patients to the trauma center.World journal of emergency surgery : WJES · 2026Article
- Undertriage in geriatric trauma: insights from a multicentre cohort study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Observational
- The impacts of ageing-related changes on prehospital trauma care for older adults: challenges and future directions.Frontiers in medicine · 2025Review
- Optimising prehospital trauma triage for older adults: challenges, limitations, and future directions.Frontiers in medicine · 2025Review
- Comparison of Manchester, qSOFA, emergency severity index, and national early warning scores for prognostic estimation and effective triage system in geriatric patients.Irish journal of medical science · 2024Article
- Relationship between systolic blood pressure and mortality in older vs younger trauma patients - a retrospective multicentre observational study.BMC emergency medicine · 2023Observational
- Accuracy of a Prehospital Triage Protocol in Predicting In-Hospital Mortality and Severe Trauma Cases among Older Adults.International journal of environmental research and public health · 2023Article
- Research priorities for prehospital care of older patients with injuries: scoping review.Age and ageing · 2022Article
- Individual risk factors predictive of major trauma in pre-hospital injured older patients: a systematic review.British paramedic journal · 2022Review
- Trauma-team-activation in Germany: how do emergency service professionals use the activation due to trauma mechanism? Results from a nationwide survey.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- Towards improving prehospital triage for older trauma patients.Zeitschrift fur Gerontologie und Geriatrie · 2021Review
- New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults.Open access emergency medicine : OAEM · 2021Review
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundComorbid conditions and anticoagulants have been considered as field triage criteria to raise the sensitivity for identifying seriously injured older adults, but research is sparse. We evaluated the utility of comorbidities, anticoagulant use, and geriatric-specific physiologic measures to improve the sensitivity of the field triage guidelines for high-risk older adults in the out-of-hospital setting.
methodsThis was a cohort study of injured adults 65 years or older transported by 44 emergency medical services agencies to 51 trauma and nontrauma hospitals in seven Oregon and Washington counties from January 1, 2011, to December 31, 2011. Out-of-hospital predictors included current field triage criteria, 13 comorbidities, preinjury anticoagulant use, and previously developed geriatric specific physiologic measures. The primary outcome (high-risk patients) was Injury Severity Score of 16 or greater or need for major nonorthopedic surgical intervention. We used binary recursive partitioning to develop a clinical decision rule with a target sensitivity of 95% or greater.
resultsThere were 5,021 older adults, of which 320 (6.4%) had Injury Severity Score of 16 or greater or required major nonorthopedic surgery. Of the 2,639 patients with preinjury medication history available, 400 (15.2%) were taking an anticoagulant. Current field triage practices were 36.6% sensitive (95% confidence interval [CI], 31.2%-42.0%) and 90.1% specific (95% CI, 89.2%-91.0%) for high-risk patients. Recursive partitioning identified (in order): any current field triage criteria, Glasgow Coma Scale score of 14 or less, geriatric-specific vital signs, and comorbidity count of 2 or more. Anticoagulant use was not identified as a predictor variable. The new criteria were 90.3% sensitive (95% CI, 86.8%-93.7%) and 17.0% specific (95% CI, 15.8%-18.1%).
conclusionsThe current field triage guidelines have poor sensitivity for high-risk older adults. Adding comorbidity information and geriatric-specific physiologic measures improved sensitivity, with a decrement in specificity. LEVEL OF EVIDENCE: Prognostic/Epidemiologic, level II.
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