Deriving a Prehospital Triage Decision Scheme for Injured Older Adults

描述(由申请人提供)：伤害是老年人死亡和残疾的主要原因，具有不成比例的高发病率、死亡率和费用。随着老年人口的迅速增长，患者和公共卫生负担也将同样增加，除非我们显著改善对这些患者的创伤护理。由美国外科医生学会开发的现场分诊决策计划，在决定是否将受伤患者运送到创伤中心时，指导基于救护车的紧急医疗服务(EMS)提供者。目前的决定方案在指导受伤老年人的治疗时，没有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、特定于年龄的因素，如先前存在的并存疾病、使用多种药物以及对可能使老年人的临床表现和结果复杂化的身体应激反应的弹性下降。已知此故障会导致分类不足，并可能导致过度分类。患者分流不足会增加他们的发病率和死亡率，而患者分流过度则增加了护理成本和急诊科的拥挤，并降低了紧急护理系统的响应能力。我们的总体目标是评估当前现场分诊决策方案识别需要创伤中心护理的老年人的能力，并确定专门为老年人制定指南是否会提高其准确性。我们将使用一项前瞻性的多中心研究的现有数据，该研究对11,892名在急诊科登记并跟踪到出院的受伤EMS患者进行了研究。在我们的建议中，我们的具体目标是：1)比较决策方案的分类准确性，以确定需要创伤中心护理的年轻人和老年人之间的患者；2)得出专门针对老年人的新的分诊决策方案；以及3)比较新的、针对老年人的决策方案的分类精度与现有的决策方案。这项研究将严格推导出第一个全面的、特定年龄的决策方案，以确定需要创伤中心护理的老年人。我们的发现将使我们能够申请R01级别的资金，前瞻性地对派生的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方案。

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.