Is medical urgency of elderly patients with traumatic brain injury underestimated by emergency department triage?

Toralph  Ruge; Axel C.  Carlsson; Magnus  Hellström; Per  Wihlborg; Johan  Undén

doi:10.1080/03009734.2019.1706674

Toralph Ruge Department of Clinical Sciences Malmö, University Hospital of Skåne, Sweden; Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
Axel C. Carlsson Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden;
Magnus Hellström Department of Surgical and Perioperative Science, Umeå University, Umeå, Sweden
Per Wihlborg Department of Clinical Sciences Malmö, University Hospital of Skåne, Sweden
Johan Undén Department of Operation and Intensive Care, Halmstad Hospital, Halmstad, Sweden; Anaesthesiology and Intensive Care Medicine, Lund University, Lund, Sweden

DOI: https://doi.org/10.1080/03009734.2019.1706674

Keywords: Elderly patients, emergency department, RETTS-A, traumatic brain injury

Abstract

Background: Mortality is high among elderly patients with traumatic brain injury (TBI). Recent data suggest that early surgical intervention and aggressive rehabilitation may reduce mortality rates even in elderly patients. Our aim was therefore to study the Rapid Emergency Triage and Treatment System–Adult (RETTS-A) triage of patients with isolated TBI and examine the differences in acute management according to age.

Methods: We included 306 adult patients with isolated severe TBI and an abbreviated injury scale (AIS) score ≥3. Using a cut-off of 60 years of age, differences in triage priority according to RETTS-A, time to first computed tomography (CT) scan, length of hospital stay (LOS), and 30-day survival were studied.

Results: In patients with an AIS score of 3 and 4, we observed that elderly patients had a longer time from admission to first CT scan. In addition, we observed that elderly patients were less often triaged with the highest priority level, despite similar AIS scores. LOS was significantly higher in elderly patients (median 9 days compared with 3 days for younger patients, p < 0.001). Finally, age, triage priority, and AIS score were independent risk factors for mortality.

Conclusion: Elderly patients with isolated TBI are managed differently than younger patients, which could be due to an under-triage of elderly patients by RETTS-A.

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