Should Age Over 70 Be a Trauma Team Activation Criterion?

June 17, 2019

Written by Clay Smith

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Trauma team activation (TTA) for age ≥70 with traumatic mechanism (vs standard TTA criteria) resulted in overtriage in 39.6% of these patients. Omitting the TTA for age only would have resulted in significant undertriage.

Why does this matter?
Age is not a current variable in determining TTA, per American College of Surgeons (ACS) guidelines. Vital sign abnormalities are less reliable in elderly patients and may result in undertriage. This trauma center has used age ≥70 years with a traumatic mechanism for TTA since 2000. Has that resulted in overtriage of such patients?

You had me at 70-year-old…
This was a retrospective review of 739 TTA in patients ≥70 over a 5-year period at a single center. 198 patients (26.8%) met the standard TTA criteria, whereas 541 (73.2%) had TTA based on age alone. Ground level falls were excluded from TTA. They found that the majority of those with TTA based solely on age had significant injuries: “49 (9%) patients died, 149 (27.5%) had ISS > 15, 65 (12%) underwent immediate intervention, 72 (13%) had ED intubations, and 306 (56.6%) required admission to the ICU.” The overtriage rate was 39.6% when TTA was based on age alone. The ACS guidelines state that, “Most agree that an acceptable percentage of overtriage is in the range of 25 to 35 percent.” These authors advocate for adding age ≥70 as a TTA criterion.

Source
Old Age With a Traumatic Mechanism of Injury Should Be a Trauma Team Activation Criterion. J Emerg Med. 2019 May 8. pii: S0736-4679(19)30263-X. doi: 10.1016/j.jemermed.2019.04.003. [Epub ahead of print]

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Reviewed by Thomas Davis