Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90

Joshua B. Brown*, Mark L. Gestring, Raquel M. Forsythe, Nicole A. Stassen, Timothy R. Billiar, Andrew B. Peitzman, Jason L. Sperry

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

103 Scopus citations

Abstract

Background: Undertriage is A Concern in Geriatric Patients. the Natl. Trauma Triage Protocol Recognized That Systolic Blood Pressure Less Than 110mmHg May Represent Shock in Those Older Than 65 Years. the Objectivewas to Evaluate the Impact of Substituting An SBPof Less Than 110mmHg for the Current SBPof Less Than 90mmHg Criterionwithin the NTTPon Triage Perf. Andmortality. Methods: Subjects Undergoing Scene Transp. in the Natl. Trauma Data Bank Were Included. the Outcome of Trauma Ctr. Need Was Defined As Inj. Severity Score Gtr. Than 15, Intensive Care U. Admission, Urgent Oper., or Emergency Dept. Death. Geriatric and Adult Cohortswere Compared. Triage Characteristics and Area under the Curve Were Compared between SBP of Less Than 110 Mm Hg and SBP of Less Than 90 Mm Hg. Hierarchical Logistic Regressionwas Used to Determinewhether Geriatric Patients Newly Triaged Positive under This Change Have A Risk of Mortality Similar to Those Triaged Positive with SBP of Less Than 90 Mm Hg. Results: Therewere 1,555,944 Subjects Included. SBPof Less Than 110mmHg Had Higher Sensitivity but Lower Specificity in Geriatric and Adult Cohorts. AUC Was Higher for SBP of Less Than 110 Mm Hg Individually in Both Geriatric and Adult Cohorts.Within the NTTP, the AUC Was Similar for SBP of Less Than 110mmHg and SBP of Less Than 90 Mm Hg in Geriatric Subjects but Was Higher for SBP of Less Than 90 Mm Hg in Adult Subjects . Substituting SBP of Less Than 110 Mm Hg Resulted in An Undertriage Reduction of 4.4% with Overtriage Increase of 4.3% in the Geriatric Cohort. Geriatric Subjects with SBP of 90 Mm Hg to 109 Mm Hg Had An Odds of Mortality Similar to Those of Geriatric Patients with SBP of Less Than 90 Mm Hg . Conclusion: SBP of Less Than 110 Mm Hg Increases Sensitivity. SBP of Less Than 110 Mm Hg Has Discrimination As Good As That of SBP of Less Than 90 Mm Hg, with Sup. Improvements in Undertriage Relative to Overtriage in Geriatric Patients. Geriatric Patients Newly Triaged to Be Positive under This Change Have A Risk of Mortality Similar to Those under the Current SBP Criterion. This Change in SBP Criteria May Be Merited in Geriatric Patients, Warranting Further Stud. to Consider Elevation to A Step 1 Criterion in the NTTP. Level of Evidence: Diagn. Stud., Level IV.

Original languageEnglish
Pages (from-to)352-359
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume78
Issue number2
DOIs
StatePublished - 1 Feb 2015
Externally publishedYes

Keywords

  • Geriatric
  • Prehospital
  • Systolic blood pressure
  • Trauma
  • Triage

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