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Evaluating Elderly-Specific Triage Tools in a Pre-hospital Setting: A Systematic Review
An aging global population results in significant changes in the demographic of major trauma patients. Despite this, current triage protocols in the United Kingdom do not include geriatric-specific parameters, leading to under-triage amongst the elderly population.
The aim of this review is to analyse the quality of elderly-focused triage systems implemented worldwide and interpret findings in the context of the United Kingdom.
Primary outcome: sensitivity and specificity of the triage tool.
Secondary outcome: percent change in-hospital mortality after elderly-specific tool implementation.
Literature search from Pubmed and Imperial databases were used to identify primary research into Geriatric Trauma and the triage tools. PRISMA criteria was used to narrow down papers. Studies were appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 and the Quality Assessment Tool for Quantitative Studies accordingly by two independent reviewers. Results from the studies were evaluated using narrative synthesis.
For the primary outcome, all 7 studies demonstrated an increase in sensitivity when compared to the non-specific protocol (17% to 160% increase). Sensitivity ranged from 13% to 96%. Only one tool met the American College of Surgeons Committee on Trauma (ACS-COT) sensitivity target (95%). All elderly-focused tools demonstrated a decrease in specificity (6.1% to 81% decrease). Specificity ranged from 17% to 93%. Three criteria met the ACS-COT specificity target (75%).
No tools met the ACS-COT targets for sensitivity and specificities simultaneously.
For the secondary outcome, 4 studies showed a percentage decrease in mortality ranging from -10.9% to -32.9%.
Despite an improvement in sensitivity of geriatric-focused triage tools, their overall diagnostic efficacy in identifying elderly trauma needs remains inadequate. Elderly-focused triage correlated with decreased mortality rates in older adults but the extent in which triage tools affected mortality was unquantified.
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