Abstract
The proportion of older adults with major trauma is increasing. High-quality care for this population requires accurate and effective prehospital trauma triage decisions. Anatomical and physiological changes with age, comorbidities, and medication use for older adults may affect the accuracy of prehospital trauma triage. This narrative review focusses on age-related anatomical and physiological changes, comorbidities, and medication use for older adults with an emphasis on their impact on the accuracy of prehospital trauma triage tools. It also addresses the efforts to develop alternative triage criteria to reduce undertriage. Age-related anatomical and physiological changes, comorbidities, and medication use were shown to affect physiological responses to injury and mechanism of injury for older people. Current triage tools poorly predicted injury severity. Geriatric-specific physiological measures and comorbidities significantly improved sensitivity with much lower specificity. Assessing anticoagulant or antiplatelet use in head injury notably improved sensitivity to identify traumatic intracranial hemorrhage, neurosurgery or death with modest decrease in specificity. Improving prehospital providers' knowledge about the challenges of assessing older people with trauma may reduce undertriage. Assessing frailty could help in improving prehospital providers' judgments. Future research is needed to improve triage decisions for this population.
Highlights
Major trauma has historically been conceived as disease condition of younger populations, resulting from high-energy mechanisms of injury [19]; this thinking is reflected in education and training approaches [5]
Scope of the Problem Prehospital trauma triage tools are developed to assess injury severity for patients to determine transportation decisions [38]. They are designed to assess the severity of a single event, which is not the case when it comes to older people who are at greater risk of silver trauma
This might be due to the process of aging, comorbidities, and medications use in older people which could affect the accuracy of prehospital triage [27]
Summary
Major trauma has historically been conceived as disease condition of younger populations, resulting from high-energy mechanisms of injury [19]; this thinking is reflected in education and training approaches [5]. Scope of the Problem Prehospital trauma triage tools are developed to assess injury severity for patients to determine transportation decisions [38]. Older trauma patients are significantly under-triaged in the prehospital phase [3, 6, 9, 22, 26, 27, 28, 33, 39] This might be due to the process of aging, comorbidities, and medications use in older people which could affect the accuracy of prehospital triage [27]. Objectives: Anatomicalal and physiologicalal changes with age, comorbidities, and medications use for older adults may affect the accuracy of prehospital trauma triage. Future research is needed to improve triage decisions for this population
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