Geriatric Trauma, Triage of
Published 2003
Published 2003
A. Level I
There is insufficient Class I and Class II data to support any standards regarding
triage of geriatric trauma patients.
B. Level II
1. Advanced patient age should lower the threshold for field triage directly to
a trauma center.
C. Level III
1. All other factors being equal, advanced patient age, in and of itself, is not predictive of poor outcomes following trauma, and therefore should NOT be used as the sole criterion for denying or limiting care in this patient population.
2. The presence of pre-existing medical conditions (PEC’s) in elderly trauma patients adversely affects outcome. However this effect becomes progressively less pronounced with advancing age.
3. In patients 65 years of age and older, a GCS < 8 is associated with a dismal prognosis. If substantial improvement in GCS is not realized within 72 hours of injury, consideration should be given to limiting further aggressive therapeutic interventions.
4. Post-injury complications in the elderly trauma patient negatively impact survival and contribute to longer lengths of stay in survivors and nonsurvivors compared to younger trauma patients. Specific therapies designed to prevent and/or reduce the occurrence of complications (particularly iatrogenic complications) should lead to optimal outcomes in this patient population.
5. With the exception of patients who are moribund on arrival, an initial aggressive approach should be pursued with the elderly trauma patient, as the majority will return home, and up to 85% will return to independent function.
6. In patients 55 years of age and older, an admission base deficit < -6 is associated with a 66% mortality. Patients in this category may benefit from in-patient triage to a high-acuity nursing unit.
7. In patients 65 years of age and older, a Trauma Score < 7 is associated with a 100 % mortality. Consideration should be given to limiting aggressive therapeutic interventions.
8. In patients 65 years of age and older, an admission respiratory rate < 10 is associated with a 100 % mortality. Consideration should be given to limiting aggressive therapeutic interventions.
9. Compared to younger trauma patients, patients 55 years of age and older are at considerably increased risk for undertriage to trauma centers even when these older patients satisfy appropriate triage criteria. The factors responsible for this phenomenon must be identified and strategies
developed to counteract it.