Pandor, A. orcid.org/0000-0003-2552-5260, Fuller, G. orcid.org/0000-0001-8532-3500, Essat, M. orcid.org/0000-0003-2397-402X et al. (4 more authors) (2022) Individual risk factors predictive of major trauma in pre-hospital injured older patients : a systematic review. British Paramedic Journal, 6 (4). pp. 26-40. ISSN 1478-4726
Abstract
Background: Older adults with major trauma are frequently under-triaged, increasing the risk of preventable morbidity and mortality. The aim of this systematic review was to identify which individual risk factors and predictors are likely to increase the risk of major trauma in elderly patients presenting to emergency medical services (EMS) following injury, to inform future elderly triage tool development.
Methods: Several electronic databases (including Medline, EMBASE, CINAHL and the Cochrane Library) were searched from inception to February 2021. Prospective or retrospective diagnostic studies were eligible if they examined a prognostic factor (often termed predictor or risk factor) for, or diagnostic test to identify, major trauma. Selection of studies, data extraction and risk of bias assessments using the Quality in Prognostic Studies (QUIPS) tool were undertaken independently by at least two reviewers. Narrative synthesis was used to summarise the findings.
Results: Nine studies, all performed in US trauma networks, met review inclusion criteria. Vital signs (Glasgow Coma Scale (GCS) score, systolic blood pressure, respiratory rate and shock index with specific elderly cut-off points), EMS provider judgement, comorbidities and certain crash scene variables (other occupants injured, occupant not independently mobile and head-on collision) were identified as significant pre-hospital variables associated with major trauma in the elderly in multi-variable analyses. Heart rate and anticoagulant were not significant predictors. Included studies were at moderate or high risk of bias, with applicability concerns secondary to selected study populations.
Conclusions: Existing pre-hospital major trauma triage tools could be optimised for elderly patients by including elderly-specific physiology thresholds. Future work should focus on more relevant reference standards and further evaluation of novel elderly relevant triage tool variables and thresholds.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2022 The Authors. This is an author-produced version of a paper subsequently published in the British Paramedic Journal. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | emergency medical services; triage; wounds and injuries |
Dates: |
|
Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research The University of Sheffield > Sheffield Teaching Hospitals |
Funding Information: | Funder Grant number National Institute for Health Research 17/16 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 25 Apr 2022 10:26 |
Last Modified: | 25 Apr 2022 12:40 |
Status: | Published |
Publisher: | The College of Paramedics |
Refereed: | Yes |
Identification Number: | 10.29045/14784726.2022.03.6.4.26 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:186018 |