Undertriage in geriatric trauma: insights from a multicentre cohort study
Abstract Background With the aging population, the number of geriatric trauma patients continues to rise, posing significant challenges for emergency care and trauma management. Structured trauma team activation (TTA) protocols aim to provide timely and adequate treatment for severely injured patien...
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2025-07-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s13049-025-01432-0 |
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| author | Daniel Anthony Koch Lars Becker Uwe Schweigkofler Paul Hagebusch Philipp Faul Christian Waydhas Florian Pavlu Markus Baacke Caspers Michael Valentin Clemens Helena Duesing Matthias Froehlich Sebastian Imach Kai-Oliver Jensen Christian Kleber Annette Keß Gerrit Matthes Andre Nohl Orkun Oezkurtul Thomas Paffrath Vera Pedersen Kai Sprengel Philipp Stoermann Heiko Trentzsch Rolf Lefering Dan Bieler Lisa Hackenberg The Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU) Germany |
| author_facet | Daniel Anthony Koch Lars Becker Uwe Schweigkofler Paul Hagebusch Philipp Faul Christian Waydhas Florian Pavlu Markus Baacke Caspers Michael Valentin Clemens Helena Duesing Matthias Froehlich Sebastian Imach Kai-Oliver Jensen Christian Kleber Annette Keß Gerrit Matthes Andre Nohl Orkun Oezkurtul Thomas Paffrath Vera Pedersen Kai Sprengel Philipp Stoermann Heiko Trentzsch Rolf Lefering Dan Bieler Lisa Hackenberg The Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU) Germany |
| author_sort | Daniel Anthony Koch |
| collection | DOAJ |
| description | Abstract Background With the aging population, the number of geriatric trauma patients continues to rise, posing significant challenges for emergency care and trauma management. Structured trauma team activation (TTA) protocols aim to provide timely and adequate treatment for severely injured patients. However, evidence suggests that current triage criteria may inadequately address the specific needs of geriatric patients, potentially leading to undertriage and worse outcomes. Methods The prospective, multicentre observational cohort study analysed trauma team activation and triage practices for patients aged ≥ 70 years across 12 Level 1 trauma centres across rural and urban regions in Germany and Switzerland. Data were prospectively collected from December 2020 to February 2021, following the STROBE guidelines. Triage decisions were compared with the TAcTIC (Trauma Team Activation and Trauma/Injury Care) consensus criteria to assess undertriage and overtriage rates. Key outcomes included trauma team activation rates, injury severity, transport characteristics, and early mortality. Results Among 3,753 trauma patients, 1,371 (36.5%) were geriatric (≥ 70 years). Trauma team activation was significantly lower in the geriatric group (15.8%) compared to younger patients (31.8%), despite similar injury severity. Post-hoc analysis revealed that 53.8% of geriatric patients requiring trauma care were undertriaged. Head injuries (47.7%) and pelvic fractures (5.7%) were more common in geriatric patients in comparison to the younger cohort. Mortality within 48 h was more than three times as high in geriatric patients (1.8% vs. 0.5%). Conclusion A significant undertriage rate (53.8%) was identified among geriatric trauma patients, contributing to delayed care and increased mortality. Undertriage of geriatric trauma patients remains a critical issue, reflecting the insufficiency of current trauma activation protocols. Tailored triage criteria that even more consider age-related physiological differences, comorbidities, and frailty are urgently needed. Future updates to trauma guidelines should aim to reduce undertriage and improve outcomes for this vulnerable population. Clinical trial number Not applicable |
| format | Article |
| id | doaj-art-6e65802b98be4fe996bddbf2c4ba332c |
| institution | Kabale University |
| issn | 1757-7241 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj-art-6e65802b98be4fe996bddbf2c4ba332c2025-08-20T03:46:21ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412025-07-013311810.1186/s13049-025-01432-0Undertriage in geriatric trauma: insights from a multicentre cohort studyDaniel Anthony Koch0Lars Becker1Uwe Schweigkofler2Paul Hagebusch3Philipp Faul4Christian Waydhas5Florian Pavlu6Markus Baacke7Caspers Michael8Valentin Clemens9Helena Duesing10Matthias Froehlich11Sebastian Imach12Kai-Oliver Jensen13Christian Kleber14Annette Keß15Gerrit Matthes16Andre Nohl17Orkun Oezkurtul18Thomas Paffrath19Vera Pedersen20Kai Sprengel21Philipp Stoermann22Heiko Trentzsch23Rolf Lefering24Dan Bieler25Lisa Hackenberg26The Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU) GermanyDepartment of Trauma Surgery and Orthopaedics, BG Unfallklinik Frankfurt am MainDepartment of Trauma Surgery, Hand- and Reconstructive Surgery, Essen UniversityDepartment of Trauma Surgery and Orthopaedics, BG Unfallklinik Frankfurt am MainDepartment of Trauma Surgery and Orthopaedics, BG Unfallklinik Frankfurt am MainDepartment of Trauma Surgery and Orthopaedics, BG Unfallklinik Frankfurt am MainDepartment of Trauma Surgery, Hand- and Reconstructive Surgery, Essen UniversityDepartment of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital KoblenzDepartment of Trauma Surgery, Hospital of the Merciful Brothers TrierDepartment of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC)Department of Orthopaedic and Trauma Surgery, Dritter Orden Clinic MunichDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital MuensterDepartment of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC)Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC)Department of Trauma, Faculty of Medicine, University Hospital Zurich (USZ)Clinic and Polyclinic for Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig AöRClinic and Polyclinic for Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig AöRDepartment of Trauma and Reconstructive Surgery, Ernst von Bergmann KlinikumCentre for Emergency Medicine, BG Klinikum DuisburgClinic and Polyclinic for Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig AöRDepartment of Trauma and Hand Surgery, Augustinerinnen HospitalDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Centre Munich (MUM), LMU KlinikumDepartment of Trauma, Faculty of Medicine, University Hospital Zurich (USZ)Department of Trauma and Orthopaedic Surgery, University Hospital FrankfurtInstitut für Notfallmedizin und Medizinmanagement (INM), LMU Klinikum, LMU MunichInstitute for Research in Operative Medicine (IFOM), Witten/Herdecke UniversityDepartment of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital KoblenzDepartment of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital KoblenzAbstract Background With the aging population, the number of geriatric trauma patients continues to rise, posing significant challenges for emergency care and trauma management. Structured trauma team activation (TTA) protocols aim to provide timely and adequate treatment for severely injured patients. However, evidence suggests that current triage criteria may inadequately address the specific needs of geriatric patients, potentially leading to undertriage and worse outcomes. Methods The prospective, multicentre observational cohort study analysed trauma team activation and triage practices for patients aged ≥ 70 years across 12 Level 1 trauma centres across rural and urban regions in Germany and Switzerland. Data were prospectively collected from December 2020 to February 2021, following the STROBE guidelines. Triage decisions were compared with the TAcTIC (Trauma Team Activation and Trauma/Injury Care) consensus criteria to assess undertriage and overtriage rates. Key outcomes included trauma team activation rates, injury severity, transport characteristics, and early mortality. Results Among 3,753 trauma patients, 1,371 (36.5%) were geriatric (≥ 70 years). Trauma team activation was significantly lower in the geriatric group (15.8%) compared to younger patients (31.8%), despite similar injury severity. Post-hoc analysis revealed that 53.8% of geriatric patients requiring trauma care were undertriaged. Head injuries (47.7%) and pelvic fractures (5.7%) were more common in geriatric patients in comparison to the younger cohort. Mortality within 48 h was more than three times as high in geriatric patients (1.8% vs. 0.5%). Conclusion A significant undertriage rate (53.8%) was identified among geriatric trauma patients, contributing to delayed care and increased mortality. Undertriage of geriatric trauma patients remains a critical issue, reflecting the insufficiency of current trauma activation protocols. Tailored triage criteria that even more consider age-related physiological differences, comorbidities, and frailty are urgently needed. Future updates to trauma guidelines should aim to reduce undertriage and improve outcomes for this vulnerable population. Clinical trial number Not applicablehttps://doi.org/10.1186/s13049-025-01432-0Severely injuredTrauma team activationGeriatric traumaGeriatric patientEmergency medicineGuideline |
| spellingShingle | Daniel Anthony Koch Lars Becker Uwe Schweigkofler Paul Hagebusch Philipp Faul Christian Waydhas Florian Pavlu Markus Baacke Caspers Michael Valentin Clemens Helena Duesing Matthias Froehlich Sebastian Imach Kai-Oliver Jensen Christian Kleber Annette Keß Gerrit Matthes Andre Nohl Orkun Oezkurtul Thomas Paffrath Vera Pedersen Kai Sprengel Philipp Stoermann Heiko Trentzsch Rolf Lefering Dan Bieler Lisa Hackenberg The Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU) Germany Undertriage in geriatric trauma: insights from a multicentre cohort study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Severely injured Trauma team activation Geriatric trauma Geriatric patient Emergency medicine Guideline |
| title | Undertriage in geriatric trauma: insights from a multicentre cohort study |
| title_full | Undertriage in geriatric trauma: insights from a multicentre cohort study |
| title_fullStr | Undertriage in geriatric trauma: insights from a multicentre cohort study |
| title_full_unstemmed | Undertriage in geriatric trauma: insights from a multicentre cohort study |
| title_short | Undertriage in geriatric trauma: insights from a multicentre cohort study |
| title_sort | undertriage in geriatric trauma insights from a multicentre cohort study |
| topic | Severely injured Trauma team activation Geriatric trauma Geriatric patient Emergency medicine Guideline |
| url | https://doi.org/10.1186/s13049-025-01432-0 |
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