Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria

Abstract

Forrest B Fernandez,1 Adrian Ong,1 Anthony P Martin,1 C William Schwab,2 Tom Wasser,3 Christopher A Butts,4 Amanda R McNicholas,1 Alison L Muller,1 Charles F Barbera,5 Rachael Trupp,5 Adam P Sigal5 1Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA; 2Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; 3Complete Statistical Services, Macungie, PA, USA; 4Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA; 5Department of Emergency Medicine, Reading Hospital, Reading, PA, USACorrespondence: Adam P SigalDepartment of Emergency Medicine, Reading Hospital, 6th Avenue and Spruce Street, P.O. Box 16052, West Reading, PA 19611, USATel [phone]Email [email protected]: Geriatric patients are at increased risk of injury following low-energy mechanisms and are less tolerant of injury. Current criteria for trauma team activation (TTA) often miss these injuries. We evaluated a novel triage process for an expedited Emergency Medicine Physician evaluation protocol (T3) for at-risk geriatric sub-populations not meeting trauma team activation (TTA) criteria.Methods: Retrospective review of injured patients (≥65 years) from a Level II Trauma Center with an Injury Severity Score (ISS < 16), prior to (Pre-T3, Jan 2007-Oct 2009), and after (Post-T3, Jan 2010-Oct 2012), implementation of T3, as well as a contemporary period (CP, Jan 2013-Oct 2015). Demographics, physiologic variables, and timeliness of care were measured. Rates of ICU admission, operative procedures and lengths of stay and in-hospital mortality were compared for all periods. Logistic regression analysis determined variables independently associated with mortality.Results: Post-T3, 49.2% of geriatric registry patients underwent T3 with a reduction in key time intervals. Median time to evaluation (42.1 mins vs 61.7 min, p<0.001), median time to CT (161.3 mins vs 212.9 mins, p<0.001) and EDLOS (364.6 mins vs 451.5 mins, p=0.023) were all reduced compared to non-expedited evaluations. There was no change in mortality after the implementation of the protocol.Conclusion: The T3 protocol expedited patient evaluation of at-risk geriatric patients that would not otherwise meet TTA criteria. The new process met the goals of the American College of Surgeons Trauma Quality Improvement Program while conserving resources.Keywords: trauma, triage, geriatrics

Keywords

• trauma geriatrics triage