Does Patient Age and Height of Fall Alone Require Trauma Team Activation?

Abstract

Our American College of Surgeons Level I trauma center uses physiological data and injury patterns to identify fall patients at risk. We hypothesized that height of fall and patient age impacted injury severity and analyzed if they were significant predictors of the need for trauma team activation. Charts were reviewed from July 1, 2004, to June 30, 2007, for age; sex; Injury Severity Score (ISS); height of fall and admission to the intensive care unit, operating room, stepdown unit, floor; or death. Exclusion criteria were physiological, neurologic, or airway compromise and penetrating neck or torso injuries. ISS was used as a positive control. A total of 1865 fall patients were treated during the period of data collection, and 1348 patients were eliminated by exclusion criteria, leaving 517 patients for study. Although patient age did not correlate with the need for trauma team activation, there was a statistically significant association between age and admission to the hospital from the emergency room (P < 0.05; area under curve [AUC] = 0.713; 95% confidence interval [CI], 0.656 to 0.770). Similarly, although the height of fall alone did not have a significant predictive value for the need of trauma team activation, there was a clear association of the height of fall with hospital admission (AUC = 0.589; 95% CI, 0.519 to 0.658). Patient age and height of fall alone are not criteria for trauma team activation in the absence of physiological, neurologic, or airway compromise.