Criteria for the qualification of geriatric patients to the trauma center.

backgroundThe growth of the geriatric population, resulting in an exponential increase in the number of injured older people, determines the necessity of ensuring adequate access to specialized units such as trauma centers (TCs). The specificity of pathophysiological processes that progress with age, worsening the body's response to trauma, makes it difficult to develop an optimal triage protocol for geriatric patients, reducing high undertriage, i.e., underestimation of injuries and referral to lower-reference units.

aimTo verify the TC qualification criteria for 65+ patients and analyze the weights of individual triage factors for these patients.

methodsThis was a retrospective analysis of the medical records of ED patients from the Clinical Hospital with TC in Poland admitted from 1.01.2017 to 31.12.2020. Among 155,320 ED patients, 6541 who formed Trauma group 65+ were selected, in which the TRISS score was estimated. The TC 65+ group meeting the currently applicable TC qualification criteria was selected. The TRISS cutoff value, TRISS 65+ group and TC-omitted 65+ group were determined. The significance of TC qualification factors was estimated. Receiver operating characteristic (ROC curve) analysis and multiple linear regression analysis were used for statistical classification.

resultsThe value of ≤ 88.84% determined the threshold for TC qualification, and the leakage of criteria was 58.51%. Six significant factors with different typing weights were identified: GCS ≤ 8 (- 42.90%), extensive crush injury of the extremities (- 33.74%), and RR < 10/min (- 16.16%), blunt injury to thoracic internal organs (- 13.75%), pelvic fracture (- 11.35%) and SBP ≤ 80 mmHg (- 10.41%) were performed. The weight + SD of each factor reduced the potential TRISSe value to ≤ 88.84% (threshold). Modifications of the cutoff values of significant physiological parameters were determined, i.e., GCS ≤ 14 (sensitivity = 79.79%, specificity = 98.25%, AUC = 0.896, Youden index = 0.780) and SBP ≤ 129 mmHg with questionable efficacy of the result.

conclusionsThe current TC qualification criteria require modification for geriatric patients, which would complete the leakage estimated at 58.51% according to the TRISS scale. The leakage results from underestimation of the weight of the 6 triage factors to the TC, and the modification of the criteria should include a reduction in the current requirement of 4 factors to 1 and allow admission to the TC of a 65+ trauma patient with one of the following anatomical injuries: extensive crush injury of extremities, blunt injuries with symptoms of damage to internal thoracic organs, pelvic fracture, or one of the disorders of physiological parameters: GCS ≤ 8, RR < 10/min, or SBP ≤ 80 mmHg. In the other cases, the modification should also take into account the change in the GCS limit value to ≤ 14 (instead of ≤ 8) and the change in the SBP cutoff value from ≤ 80 mmHg to a higher one (but ≤ 129 mmHg) or the use of another factor. To complete the formula (undertriage according to ISS = 73.47%), additional factors, such as the mechanism of injury, must be included. It is necessary to develop research on the criteria for the qualification of geriatric patients to the TC, and the use of weight analysis of individual factors may contribute to the identification of properly balanced triage criteria.