Abstract
Key summary pointsAim The systematic review aimed to assess the under-triage rate for older trauma patients in prehospital care and its impact on their outcomes. Findings Older trauma patients were significantly under-triaged in prehospital care and the benefits of triaging these patients to Tauma Centres (TCs) are still uncertain. Current triage criteria and developed geriatric-specific criteria lacked acceptable accuracy and when patients met the criteria, they had a low chance of being transported to TCs. Message Future worldwide research is needed to assess the following aspects: (1) the accuracy of current trauma triage criteria, (2) developing more accurate triage criteria, (3) destination compliance rates for patients meeting the triage criteria, (4) factors leading to destination non-compliance and their impact on outcomes, and (5) the benefits of TC access for older trauma patients.
Background It is argued that many older trauma patients are under-triaged in prehospital care which may adversely affect their outcomes. This systematic review aimed to assess prehospital under-triage rates for older trauma patients, the accuracy of the triage criteria, and the impact of prehospital triage decisions on outcomes. Methods A computerised literature search using MEDLINE, Scopus, and CINHAL databases was conducted for studies published between 1966 and 2021 using a list of predetermined index terms and their associated alternatives. Studies which met the inclusion criteria were included and critiqued using the Critical Appraisal Skills Programme tool. Due to the heterogeneity of the included studies, narrative synthesis was used in this systematic review. Results Of the 280 identified studies, 23 met the inclusion criteria. Current trauma triage guidelines have poor sensitivity to identify major trauma and the need for TC care for older adults. Although modified triage tools for this population have improved sensitivity, they showed significantly decreased specificity or were not applied to all older people. The issue of low rates of TC transport for positively triaged older patients is not well understood. Furthermore, the benefits of TC treatment for older patients remain uncertain. Conclusions This systematic review showed that under-triage is an ongoing issue for older trauma patients in prehospital care and its impact on their outcomes is still uncertain. Further high-quality prospective research is needed to assess the accuracy of prehospital triage criteria, the factors other than the triage criteria that affect transport decisions, and the impact of under-triage on outcomes.