Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr-Jun;19(2):202-12.
doi: 10.3109/10903127.2014.959225. Epub 2014 Oct 7.

Identification of a neurologic scale that optimizes EMS detection of older adult traumatic brain injury patients who require transport to a trauma center

Erin B Wasserman, Manish N Shah, Courtney M C Jones, Jeremy T Cushman, Jeffrey M Caterino, Jeffrey J Bazarian, Suzanne M Gillespie, Julius D Cheng, Ann Dozier

Identification of a neurologic scale that optimizes EMS detection of older adult traumatic brain injury patients who require transport to a trauma center

Erin B Wasserman et al. Prehosp Emerg Care. 2015 Apr-Jun.

Abstract

Objective: We sought to identify a scale or components of a scale that optimize detection of older adult traumatic brain injury (TBI) patients who require transport to a trauma center, regardless of mechanism.

Methods: We assembled a consensus panel consisting of nine experts in geriatric emergency medicine, prehospital medicine, trauma surgery, geriatric medicine, and TBI, as well as prehospital providers, to evaluate the existing scales used to identify TBI. We reviewed the relevant literature and solicited group feedback to create a list of candidate scales and criteria for evaluation. Using the nominal group technique, scales were evaluated by the expert panel through an iterative process until consensus was achieved.

Results: We identified 15 scales for evaluation. The panel's criteria for rating the scales included ease of administration, prehospital familiarity with scale components, feasibility of use with older adults, time to administer, and strength of evidence for their performance in the prehospital setting. After review and discussion of aggregated ratings, the panel identified the Simplified Motor Scale, GCS-Motor Component, and AVPU (alert, voice, pain, unresponsive) as the strongest scales, but determined that none meet all EMS provider and patient needs due to poor usability and lack of supportive evidence. The panel proposed that a dichotomized decision scheme that includes domains of the top-rated scales -level of alertness (alert vs. not alert) and motor function (obeys commands vs. does not obey) -may be more effective in identifying older adult TBI patients who require transport to a trauma center in the prehospital setting.

Conclusions: Existing scales to identify TBI are inadequate to detect older adult TBI patients who require transport to a trauma center. A new algorithm, derived from elements of previously established scales, has the potential to guide prehospital providers in improving the triage of older adult TBI patients, but needs further evaluation prior to use.

Keywords: brain injuries; emergency medical services; geriatrics; triage.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Panel-devised decision scheme for detecting older adult TBI patients who require transport to a trauma center.
See this image and copyright information in PMC

References

    1. Faul M, Xu L, Wald MM, Coronado VG Centers for Disease Control and Prevention. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2010
    1. Dams-O'Connor K, Cuthbert JP, Whyte J, Corrigan JD, Faul M, Harrison-Felix C. Traumatic brain injury among older adults at Level I and II trauma centers. Journal of neurotrauma. 2013;30:2001–2013. - PMC - PubMed
    1. Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc. 2006;54:1590–1595. - PMC - PubMed
    1. Coronado VG, Thomas KE, Sattin RW, Johnson RL. The CDC traumatic brain injury surveillance system: characteristics of persons aged 65 years and older hospitalized with a TBI. J Head Trauma Rehabil. 2005;20:215–228. - PubMed
    1. Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, Guzman BR, Hemphill JD. Surveillance for traumatic brain injury-related deaths--United States, 1997–2007. MMWR Surveill Summ. 2011;60:1–32. - PubMed

LinkOut - more resources