The Failure of Triage Criteria to Identify Geriatric Patients with Trauma

TLDR

Florida’s trauma scorecard uses eight criteria to triage adults, but concerns have risen that it may inadequately identify older patients. The study aimed to evaluate the effectiveness of these criteria for adults, with special focus on geriatric trauma. The analysis revealed that the scorecard leads to unacceptable undertriage rates among patients aged 55 and older with life‑threatening injuries.

Abstract

Since 1990, Florida has used a uniform set of eight triage criteria, known as the trauma scorecard, for triaging adult patients with trauma to state-approved trauma centers. If any one of the eight criteria are met, paramedics classify the patient as a "trauma alert" and transport to a state-approved trauma center. Widespread concern within the trauma care community that the scorecard was not providing an effective tool for adult trauma triage, particularly for older adults, was a motivating force for conducting an evaluation of the trauma scorecard's performance. Thus, the Florida Department of Health and Rehabilitative Services, Office of Emergency Medical Services initiated a research effort to assess the effectiveness of the state-adopted trauma triage criteria for adults, giving special attention to geriatric trauma. The results of the Florida Trauma Triage Study indicate that the eight triage criteria comprising the trauma scorecard produce unacceptable levels of undertriage in elderly patients (age 55 years or older) with life-threatening injuries.