Does an age modifier enhance trauma triage for older people who suffer major trauma?

Older people face higher risks of complications and mortality following trauma and are overrepresented among major trauma victims. Historically, trauma criteria under-triaged older patients. From 2016 to 2023, the Trauma Team at Royal University Hospital used triage criteria allowing up-triage of people over 65 from Level 2 to Level 1. Only Level 1 Trauma leads to Trauma Team Activation.

This project aimed to determine if this age modifier improved the sensitivity and specificity of trauma triage criteria for older people with major trauma. Secondary objectives included evaluating injury severity, interventions, morbidity, and mortality of older versus younger trauma patients.

A retrospective chart review of all Level 1 and 2 trauma patients at RUH ED from January 1, 2016, to December 31, 2022, was conducted. The data is incomplete, but interim analysis shows older adults were often categorized as Level 1 trauma due to age rather than physiologic or mechanistic criteria. Despite this, they had increased complications, Alternate Level of Care designations, and mortality, despite similar initial injury severity scores. Some findings may be due to the increased complexity of older trauma patients.