1 / 23

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

Download Presentation

Ohio State Board of Emergency Medical Services Trauma Committee

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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

More Related