Prehospital factors associated with severe injury in older adults

Abstract

Introduction: Globally, injury is amongst the leading causes of death and disability in all age groups. Despite the use of prehospital trauma triage guidelines, identification of older persons with severe,potentially life-threatening injuries has been problematic. The purpose of this paper is to review prehospital factors associated with severe injuries amongst older adults.

Search strategy: MEDLINE, CINAHL, Embase, and Cochrane databases were searched using key word searches of natural language and MeSH vocabulary. Criteria for final retention of the articles included: a focus on adults 50 years and older, single or multisystem injury and identification of prehospital (injury scene) factors associated with severe injury. Severe injury was defined as a maximum Abbreviated Injury Score (MAIS) ≥ 3 or an injury severity score ≥ 16, including fatal injury.

Results: The database searches yielded 469 unduplicated citations. Snowball searching yielded an additional 17 citations. Of these 486 citations, 19 research studies and 2 reviews with practice guidelines met the retention criteria. All of the research studies were secondary analyses, involving the use of hospital trauma registries, injury databases, patient medical records, and statewide hospital discharge data. These studies were conducted in the United States (US), Canada, and the United Kingdom (UK).Factors associated with severe injury included age, sex, systolic blood pressure, pulse, Glasgow ComaScale (GCS) score, use of anticoagulant and antiplatelet agents, angle of impact, restraint systems,occupant mobility at the scene, and number of persons injured.

Discussion and conclusions: The literature has two significant limitations: the lack of prospective studies of older trauma patient triage indicators and a lack of clarity in many published discussions related to the cause of injury mortality, i.e., whether deaths resulted from the direct effects of the injury or from complications, the effect of comorbidities, or a combination of these. The strongest evidence available at this time consists of retrospective analyses. There might be additional unidentified prehospital factors associated with severe injury in this population that have greater sensitivity, specificity, and predictive validity than current indicators. Seeking and validating such factors and validating existing triage indicators must assume priority amongst investigators and funding agencies.