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Ohio State Board of Emergency Medical Services Trauma Committee

Ohio State Board of Emergency Medical Services Trauma Committee. Geriatric Trauma Triage Criteria: How and Why. Required Review. EMS Board is required by law to review their trauma triage criteria every three years to minimize overtriage and undertriage

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Ohio State Board of Emergency Medical Services Trauma Committee

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  1. Ohio State Board of Emergency Medical ServicesTrauma Committee Geriatric Trauma Triage Criteria: How and Why

  2. Required Review • EMS Board is required by law to review their trauma triage criteria every three years to minimize overtriage and undertriage • Solicitation of public input also required • 1st 3-year review in 2005 • A recommendation to treat geriatrics as a distinct, special needs population was received.

  3. Data: First Blush

  4. Discussion ensues • Evidence shows… • Elderly have worse outcomes than younger trauma patients with similar injuries • Trauma patients have better outcomes when treated at trauma centers • But Ohio has no geriatric-specific triage criteria • Age is simply a “consideration”

  5. Action follows • Trauma Committee forms Geriatric Trauma Task Force • Howard Werman, MD – Chair • Charged with finding evidence of need for geriatric-specific triage criteria • Utilizing current literature and data within the Ohio Trauma Registry and EMS Incident Reporting System

  6. Step 1 • Define “old” • Literature unhelpful • Geriatric age groups begin anywhere from age 54 to 75 • No basis for selection • Need to create evidence-based definition using Ohio data

  7. Gross Mortality

  8. Magic number: 72 • At age 72, gross mortality went above, and stayed above, 4% • Overall mortality in OTR - 3.6% • 72 years old was cut point for gross mortality for • All trauma patients • Minor injuries (ISS 1-9) • Moderate injuries (ISS 10-15) • Severe injuries (ISS >15) • Trauma patients with blunt injuries • Trauma patients with penetrating injuries

  9. Statistical validation

  10. “Old” defined • Geriatric trauma patients defined as =>70 years of age • Rounded down to make it easier to remember

  11. Step 2 • Find factors that indicate a need for direct transport to a trauma center based on significantly higher mortality • Anatomic • Physiologic • Mechanistic

  12. Step 2 • Methodology • Compare outcomes for theoretical indicators in the geriatric population versus the adult population (age 16-69)

  13. Step 2 • Proposed indicators • Falls (any height, including standing) associated with TBI, chest, abdominal or spinal injury • Pedestrian struck • MVC with single proximal long bone fracture • Multiple body regions injured • Hypotension (initial systolic B/P) • Altered LOC (initial GCS score)

  14. Step 2 • Proposed indicators • Co-morbid conditions • Any • COPD • Coronary Artery Disease • Cardiac Disease (any) • Clotting disorder (including Coumadin therapy) • Diabetes (Type 1 or Type 2) • Dialysis • Immunocompromised • Liver Disease

  15. Results

  16. Results

  17. Results

  18. Results • Proposed indicators • Falls (any height, including standing) associated with • TBI  • Chest injury • Abdominal injury • Pedestrian struck • MVC with single proximal long bone fracture • Multiple body regions injured  • TBI • Head/face/neck • Chest • Abdomen/pelvis • Spine • Extremities

  19. Results • Co-morbid conditions • Any • COPD • Coronary Artery Disease • Cardiac Disease (any) • Clotting disorder (including Coumadin therapy) • Diabetes (Type 1 or Type 2) • Dialysis • Immunocompromised • Liver Disease

  20. Recommendations to EMS Board Trauma patients =>70 years should be defined as geriatric trauma. They should be triaged for evaluation in a trauma center for: • GCS < 15 with evidence of traumatic brain injury • Systolic BP < 100 mmHg • Falls with evidence of traumatic brain injury (even from standing position) • Pedestrian struck by motor vehicle • Multiple body regions injured • Known or suspected proximal long bone fracture sustained in a motor vehicle crash

  21. Impact • Estimated change in admissions to hospitals (based on applying new criteria to previous year’s trauma registry data): • Non-trauma hospitals estimated to admit an average of 11.4 fewer patients annually

  22. Implementation • Trauma Committee recommended EMS Board make changes to triage criteria based on this research • Triage criteria set in rule (Ohio Administrative Code) • Rule revision process takes 3-6 months • EMS Board accepted changes in October 2008 • New triage rules implemented December 29, 2008

  23. Full report to EMS Board and analysis of change in admission patterns available in Data Center section of EMS Division website ems.ohio.gov

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