Trauma team activation criteria and outcomes of geriatric trauma: 10?year single centre cohort study - 07/08/18

Doi : 10.1016/j.ajem.2018.06.011

Kevin Kei-ching Hung, FHKCEM ^a,^b, Janice H.H. Yeung, PhD ^a,^b, Catherine S.K. Cheung, MSc ^a, Ling-yan Leung, PhD ^a, Raymond C.H. Cheng, FHKCEM ^a,^b, N.K. Cheung, FHKCEM ^a,^b, Colin A. Graham, MD ^a,^b,^{^⁎}
^a Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong
^b Accident & Emergency Department, Prince of Wales Hospital, Shatin, New Territories, Hong Kong

^⁎Corresponding author at: Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.Accident and Emergency Medicine Academic UnitThe Chinese University of Hong KongTrauma & Emergency CentrePrince of Wales HospitalShatinNew TerritoriesHong Kong

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 07 August 2018
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Abstract

Background

With the aging population, the number of older patients with multiple injuries is increasing. The aim of this study was to understand the patterns and outcomes of older patients admitted to a major trauma centre in Hong Kong from 2006 to 2015, and investigate the performance of the trauma team activation (TTA) criteria for these elderly patients.

Methods

This was a retrospective cohort study from a university hospital major trauma centre in Hong Kong from 2006 to 2015. Patients aged 55 or above who entered the trauma registry were included. Patients were divided into those aged 55–70, and above 70. To test the performance of the TTA criteria, we defined injured patients with severe outcomes as those having any of the following: death within 30 days; the need for surgery; or the need for intensive care unit (ICU) care.

Results

2218 patients were included over the 10 year period. The 30-day mortality was 7.5% for aged 55–70 and 17.7% for those aged above 70. The sensitivity of TTA criteria for identifying severe outcomes for those aged 55 or above was 35.6%, with 91.6% specificity. The under-triage rate was 59% for age 55–70, and 69.1% for those aged above 70.

Conclusion

There is a need to consider alternative TTA criteria for our geriatric trauma population, and to more clearly define the process and standards of care in Hong Kong.

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Keywords : Geriatrics, Trauma centres, Trauma severity indices, Multiple trauma, Accidental falls, Traffic accidents, Cohort studies, Outcomes, Hong Kong