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、死亡率和成本。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将同样扩大。由美国外科医师学会制定的现场分诊决策方案，指导以救护车为基础的紧急医疗服务（EMS）提供者决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老年人受伤的管理时，没有考虑到衰老带来的生理和临床挑战。它没有考虑到独特的、年龄特定的因素，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果复杂化。这种失败会导致分诊不足，也可能导致分诊过多。分诊不足的患者将增加其发病率和死亡率的风险，而分诊过多的患者增加了护理成本和急诊科拥挤，并降低了紧急护理系统的反应能力。我们的总体目标是评估当前的现场分类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名急诊受伤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，以识别需要创伤中心护理的年轻人和老年人；2)提出了一种新的老年人分诊决策方案；3)比较新的老年人特定决策方案与现有决策方案的分类精度。本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。我们的研究结果将使我们能够申请r01级别的资金，对衍生的决策方案进行前瞻性的多中心验证，并为EMS提供者在照顾受伤的老年人时使用的方案提供信息。

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.