Deriving a Prehospital Triage Decision Scheme for Injured Older Adults

制定受伤老年人的院前分诊决策方案

• 批准号: 8280547
• 负责人: MANISH N SHAH
• 金额: $ 8.63万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8280547
• 关键词: Accident and Emergency department; Accounting; Admission activity; Age; Aging; Ambulances; American College of Surgeons; Anatomy; Anticoagulants; Caring; Case Fatality Rates; Cause of Death; Classification; Clinical; Comorbidity; Complex; Crowding; Data; Data Set; Development; Elderly; Emergency Care; Emergency medical service; Enrollment; Failure; Funding; Goals; Guidelines; Healthcare; Hospitalization; Hospitals; Hypotension; Individual; Injury; Lead; Logistic Regressions; Medical; Methods; Morbidity - disease rate; Outcome; Patients; Performance; Pharmaceutical Preparations; Physiological; Population; Procedures; Productivity; Prospective Studies; Protocols documentation; Provider; Public Health; Publishing; Registries; Risk; Scheme; Source; Specificity; Trauma; Trees; Triage; Validation; base; care systems; cost; disability; high risk; improved; injured; mortality; operation; patient oriented; prospective; stressor; trauma care; trauma centers; young adult

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.

描述（由申请人提供）：受伤是老年人死亡和残疾的主要原因，发病率高，死亡率和成本高。随着老年人群体的迅速扩大，除非我们显着改善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。美国外科医生学院制定的现场分类决策计划指导总部位于救护车的紧急医疗服务（EMS）提供者，以确定是否将受伤的患者运送到创伤中心。当前的决策计划在指导受伤的老年人的管理时衰老所带来的生理和临床挑战很差。它不说明独特的特定年龄因素，例如先前存在的合并症，多种药物的使用以及对响应身体压力响应的弹性，这可能会使老年人的临床表现和结果复杂化。众所周知，这种失败会导致资产不足，并可能导致过度交易。不足的患者会增加发病率和死亡率的风险，而过度贸易患者增加了护理和急诊部门的拥挤，并降低了急诊护理系统的响应能力。我们的总体目标是评估当前的现场分类决策计划的能力，即确定需要创伤中心护理的老年人，并确定专门为老年人创建指南是否会提高其准确性。我们将使用一项预期的多中心研究中的现有数据，该研究对急诊科的11,892名受伤的EMS患者进行了研究，并随后出院。在我们的建议中，我们专门针对以下方式：1）比较决策计划的分类准确性，以识别需要年轻人和老年人之间需要创伤中心护理的患者； 2）为老年人提供新的分类决策计划； 3）将新的，特定于成人的决策方案的分类精度与到位的决策方案进行比较。这项研究将严格得出第一个综合，特定年龄的决策计划，以确定需要创伤中心护理的老年人。我们的发现将使我们能够申请R01级资金，以预期对派生的决策计划进行多中心验证，并在照顾受伤的老年人时通知EMS提供商使用的协议。 公共卫生相关性：陈述受伤是老年人死亡和残疾的主要原因，发病率，死亡率和成本高度高。随着老年人群体的迅速扩大，除非我们显着改善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。当前的指南用于分类，在创伤中心和非创伤中心医院之间受伤的老年人受伤，对老龄化构成的生理和临床挑战很差，导致了过度和不足的交易以及两者的有害后果。这项研究将严格得出第一个综合，特定年龄的分类指南，以确定需要创伤中心护理的老年人。我们的发现将允许对前瞻性研究的发展和表现，以验证分流指南，告知EMS提供者在照顾受伤的老年人时使用的方案，并最终改善受伤的老年人患者的护理。