|مجال التميز||تميز دراسي و بحثي|
New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults
|رابط إلى البحث:||https://www.dovepress.com/new-horizons-in-understanding-appropriate-prehospital-identification-a-peer-reviewed-fulltext-article-OAEM|
|موجز عن البحث:||Caring for older people is an important part of prehospital practice, including appropriate triage and transportation decisions. However, prehospital triage criteria are designed to predominantly assess injury severity or high-energy mechanism which is not the case for older people who often have injuries compounded by multimorbidity and frailty. This has led to high rates of under-triage in this population. This narrative review aimed to assess aspects other than triage criteria to better understand and improve prehospital triage decisions for older trauma patients. This includes integrating frailty assessment in prehospital trauma triage, which was shown to predict adverse outcomes for older trauma patients. Furthermore, determining appropriate outcome measures and the benefits of Major Trauma Centers (MTCs) for older trauma patients should be considered in order to direct accurate and more beneficial prehospital trauma triage decisions. It is still not clear what are the appropriate outcome measures that should be applied when caring for older trauma patients. There is also no strong consensus about the benefits of MTC access for older trauma patients with regards to survival, in-hospital length of stay, discharge disposition, and complications. Moreover, looking into factors other than triage criteria such as distance to MTCs, patient or relative choice, training, unfamiliarity with protocols, and possible ageism, which were shown to impact prehospital triage decisions but their impact on outcomes has not been investigated yet, should be more actively assessed and investigated for this population. Therefore, this paper aimed to discuss the available evidence around frailty assessment in prehospital care, appropriate outcome measures for older trauma patients, the benefits of MTC access for older patients, and factors other than triage criteria that could adversely impact accurate prehospital triage decisions for older trauma patients. It also provided several suggestions for the future.|
|عنوان البحث:||Towards improving prehospital triage for older trauma patients|
|رابط إلى البحث:||https://link.springer.com/article/10.1007%2Fs00391-021-01844-4|
|موجز عن البحث:||
Background: The proportion of older adults with major trauma is increasing. High-quality care for this population requires accurate and effective prehospital trauma triage decisions.
Objective: Anatomical and physiological changes with age, comorbidities, and medication use for older adults may affect the accuracy of prehospital trauma triage.
Material and methods: This narrative review focusses on age-related anatomical and physiological changes, comorbidities, and medication use for older adults with an emphasis on their impact on the accuracy of prehospital trauma triage tools. It also addresses the efforts to develop alternative triage criteria to reduce undertriage.
Results: Age-related anatomical and physiological changes, comorbidities, and medication use were shown to affect physiological responses to injury and mechanism of injury for older people. Current triage tools poorly predicted injury severity. Geriatric-specific physiological measures and comorbidities significantly improved sensitivity with much lower specificity. Assessing anticoagulant or antiplatelet use in head injury notably improved sensitivity to identify traumatic intracranial hemorrhage, neurosurgery or death with modest decrease in specificity.
Conclusion: Improving prehospital providers’ knowledge about the challenges of assessing older people with trauma may reduce undertriage. Assessing frailty could help in improving prehospital providers’ judgments. Future research is needed to improve triage decisions for this population.
|عنوان البحث:||A consensus building exercise to determine research priorities for silver trauma|
|رابط إلى البحث:||https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-020-00357-4|
|موجز عن البحث:||
Emergency care research into ‘Silver Trauma’, which is simply defined as major trauma consequent upon relatively minor injury mechanisms, is facing many challenges including that at present, there is no clear prioritisation of the issues. This study aimed to determine the top research priorities to guide future research.
This consensus-based prioritization exercise used a three-stage modified Delphi technique. The study consisted of an idea generating (divergent) first round, a ranking evaluation in the second round, and a (convergent) consensus meeting in the third round.
A total of 20 research questions advanced to the final round of this study. After discussing the importance and clinical significance of each research question, five research questions were prioritised by the experts; the top three research priorities were:
(1). What are older people’s preferred goals of trauma care?
(2). Beyond the Emergency Department (ED), what is the appropriate combined geriatric and trauma care?
(3). Do older adults benefit from access to trauma centres? If so, do older trauma patients have equitable access to trauma centre compared to younger adults?
The results of this study will assist clinicians, researchers, and organisations that are interested in silver trauma in guiding their future efforts and funding toward addressing the identified research priorities.
|عنوان البحث:||Building consensus to enhance research: A study protocol to determine the top issues to improve outcomes of Silver Trauma|
|رابط إلى البحث:||https://journals.le.ac.uk/ojs1/index.php/lias/article/view/3224/2903|
|موجز عن البحث:||Improving outcomes for silver trauma requires more active research in this field. However, complexity in understanding research priorities and lack of strong evidence represent a major obstacle to which areas future research should be directed. Therefore, this study protocol aims to build consensus of the top research priorities for improving outcomes of injured older adults. This study will also highlight the current issues in trauma care for older people and contribute a more collaborative and interdisciplinary work among experts who are interested in trauma care for older people. This will be achieved by conducting a modified Delphi technique which consists of three rounds: 1) a divergent phase to elicit a broad range of views, 2) a convergent ranking process (ranking the issues identified in round I), and 3) a consensus meeting (determining to the top three issues of those met the predetermined consensus threshold in round II). Experts from different disciplines who are interested in silver trauma will be invited to participate in this study. This, in turn, will enhance the interdisciplinary work among expert who share the same interest to prioritise the issues in improving outcomes for injured older adults.|
عبدالله نايف عبدالله الشيباني
الطب والخدمات الصحية
University of Leicester