Deriving a Prehospital Triage Decision Scheme for Injured Older Adults

制定受伤老年人的院前分诊决策方案

• 批准号: 8280547
• 负责人: MANISH N SHAH
• 金额: $ 8.63万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8280547
• 关键词: Accident and Emergency department; Accounting; Admission activity; Age; Aging; Ambulances; American College of Surgeons; Anatomy; Anticoagulants; Caring; Case Fatality Rates; Cause of Death; Classification; Clinical; Comorbidity; Complex; Crowding; Data; Data Set; Development; Elderly; Emergency Care; Emergency medical service; Enrollment; Failure; Funding; Goals; Guidelines; Healthcare; Hospitalization; Hospitals; Hypotension; Individual; Injury; Lead; Logistic Regressions; Medical; Methods; Morbidity - disease rate; Outcome; Patients; Performance; Pharmaceutical Preparations; Physiological; Population; Procedures; Productivity; Prospective Studies; Protocols documentation; Provider; Public Health; Publishing; Registries; Risk; Scheme; Source; Specificity; Trauma; Trees; Triage; Validation; base; care systems; cost; disability; high risk; improved; injured; mortality; operation; patient oriented; prospective; stressor; trauma care; trauma centers; young adult

DESCRIPTION (provided by applicant): Injury is a leading cause of death and disability among older adults, with a disproportionately high morbidity, mortality, and cost. As the older adult population rapidly expands, the patient and public health burden will similarly expand unless we significantly improve trauma care for these patients. The Field Triage Decision Scheme, developed by the American College of Surgeons, guides ambulance-based emergency medical services (EMS) providers when determining whether to transport injured patients to a trauma center. The current Decision Scheme poorly considers the physiological and clinical challenges posed by aging when guiding the management of injured older adults. It does not account for unique, age-specific factors such as pre-existing co-morbidities, use of multiple medications, and compromised resiliency for responding to physical stressors which can complicate older adults' clinical presentation and outcomes. This failure is known to lead to under-triage, and may lead to over-triage. Under-triage of patients will increase their risk of morbidity and mortality, whereas over-triage of patients adds to the cost of care and emergency department crowding, and decrease the responsiveness of the emergency care system. Our overall goal is to assess the current Field Triage Decision Scheme's ability to identify older adults who need trauma center care and determine whether creating guidelines specifically for older adults would improve its accuracy. We will use existing data from a prospective, multi-center study of 11,892 injured EMS patients enrolled in the emergency department and followed to hospital discharge. In our proposal, we specifically aim to: 1) compare the classification accuracy of the Decision Scheme to identify patients who require trauma center care between younger and older adults; 2) derive a new triage decision scheme specifically for older adults; and 3) compare the classification accuracy of the new, older adult-specific decision scheme to the Decision Scheme in place. This study will rigorously derive the first comprehensive, age-specific decision scheme to identify older adults needing trauma center care. Our findings will allow us to apply for R01-level funding to prospectively conduct a multi-center validation of the derived decision scheme and to inform the protocols used by EMS providers when caring for injured older adults. PUBLIC HEALTH RELEVANCE: Statement Injury is a leading cause of death and disability among older adults, with a disproportionately high morbidity, mortality, and cost. As the older adult population rapidly expands, the patient and public health burden will similarly expand unless we significantly improve trauma care for these patients. The current guideline used to triage injured older adults between trauma centers and non-trauma center hospitals poorly considers the physiological and clinical challenges posed by aging, leading to over- and under-triage and the deleterious consequence of both. This study will rigorously derive the first comprehensive, age-specific triage guideline to identify older adults needing trauma center care. Our findings will allow development and performance of a prospective study to validate the triage guideline, inform the protocols used by EMS providers when caring for injured older adults, and will ultimately improve the care for injured older adult patients.

描述（由申请人提供）：伤害是老年人死亡和残疾的主要原因，发病率、死亡率和成本不成比例地高。随着老年人口的迅速扩大，除非我们显著改善对这些患者的创伤护理，否则患者和公共卫生负担也将同样扩大。由美国外科医生学会制定的现场分诊决策计划指导救护车紧急医疗服务（EMS）提供者确定是否将受伤患者运送到创伤中心。目前的决策方案在指导受伤老年人的管理时，没有充分考虑到老龄化带来的生理和临床挑战。它没有考虑到独特的年龄特异性因素，如预先存在的合并症，多种药物的使用，以及对身体压力源的反应能力受损，这些因素可能使老年人的临床表现和结局复杂化。已知这种故障会导致分流不足，并可能导致过度分流。对患者分类不足将增加其发病率和死亡率的风险，而对患者分类过度会增加护理成本和急诊科拥挤，并降低急诊护理系统的反应能力。我们的总体目标是评估目前的现场分诊决策计划的能力，以确定老年人谁需要创伤中心护理，并确定是否专门为老年人创建指南将提高其准确性。我们将使用来自一项前瞻性多中心研究的现有数据，该研究纳入了11，892名急诊科受伤的EMS患者，并随访至出院。在我们的提案中，我们的具体目标是：1）比较决策方案的分类准确性，以识别需要年轻人和老年人之间创伤中心护理的患者; 2）推导出专门针对老年人的新的分诊决策方案; 3）比较新的老年人特定决策方案与决策方案的分类准确性。这项研究将严格推导出第一个全面的、针对特定年龄的决策方案，以确定需要创伤中心护理的老年人。我们的研究结果将使我们能够申请R 01级资金，以前瞻性地对衍生决策方案进行多中心验证，并告知EMS提供者在照顾受伤的老年人时使用的协议。 公共卫生相关性：伤害是老年人死亡和残疾的主要原因，发病率、死亡率和成本都不成比例地高。随着老年人口的迅速扩大，除非我们显著改善对这些患者的创伤护理，否则患者和公共卫生负担也将同样扩大。目前用于在创伤中心和非创伤中心医院之间对受伤的老年人进行分诊的指南没有充分考虑老龄化带来的生理和临床挑战，导致过度和不足的分诊以及两者的有害后果。这项研究将严格推导出第一个全面的，针对特定年龄的分流指南，以确定需要创伤中心护理的老年人。我们的研究结果将允许开发和执行一项前瞻性研究，以验证分诊指南，告知EMS提供者在照顾受伤的老年人时使用的协议，并最终改善对受伤老年人的护理。