Prehospital trauma triage leaves much to be desired, study says

Paramedics deliver a person to a Montreal hospital on a stretcher, on December 29, 2021. -- FILE PHOTO (THE CANADIAN PRESS/Graham Hughes)

A Laval University study found that prehospital triage of trauma victims is rather unsatisfactory, especially when it comes to the elderly.

The triage protocol used in Quebec detects just over half of the patients who need rapid transport to a trauma centre, the study says, and it is the elderly who are most likely to suffer from these shortcomings.

"We know that it's difficult to identify an elderly person who has a severe trauma," said study leader Dr. Eric Mercier, a professor in the Faculty of Medicine at Laval University and an emergency physician and trauma team leader at the Enfant-Jésus Hospital of the CHU of Quebec.

Mercier and his colleagues studied the cases of 822 patients transported to an emergency department in the Quebec City area between November 2016 and March 2017.

All of these patients had suffered a trauma, primarily due to a fall (65 per cent of cases) or an accident involving a motor vehicle (22 per cent of cases). Two-thirds of the patients were 55 years or older.

Paramedics arriving at the scene of an accident assess the victim's condition using the Quebec Prehospital Trauma Triage Scale (EQTPT). The tool, which has been in use since 2016, includes five categories of criteria that allow these first responders to determine whether the victim should be transported to a hospital emergency room or a trauma centre emergency room.

Researchers found that the EQTPT correctly identifies 57 per cent of patients who should have been transported to a trauma centre. This percentage decreases with age and stands at only 30 per cent for those 75 years and older.

Mercier points out that this scale is adapted from an American tool that was designed for young people in good health before their accident. It therefore loses much of its effectiveness and relevance at a time when one is seeing a decreasing proportion of injuries among young people and a growing aging population with a more complex profile.

"Unlike a young person who has just had an accident with their motorcycle, an elderly person who has suffered a trauma may simply have had a fall at home. For example, in this study, 95 per cent of the patients 85 years and older who had suffered a trauma had fallen from their height," said Dr. Mercier.

"Now, more than 50 per cent of the patients hospitalized in a trauma centre are 65 years and older," he said. "So you can't expect to apply the same criteria to someone who has had a motorcycle accident and is in good health as to someone who is 85 years old and has fallen from their height."

Older people may also have cognitive problems that cause them to be confused. But since confusion can also be a sign of head trauma, paramedics may struggle to sort it out within minutes of the accident.

Elderly people are also often taking medications that will alter the body's physiological response to trauma.

Still, there is robust evidence that being transported directly to a trauma centre improves the prognosis of patients with high needs or major trauma, Mercier says.

"It can reduce mortality, but it can also reduce morbidity," he added.

He is now proposing the development of a new tool that would more clearly identify those patients who need to be transported to a hospital and those who need to be transported to a trauma centre, as well as those who do not need transportation and can stay at home, for example, while waiting to see their family physician or to receive a visit from a nurse.

"The development of a tool like that, I think, would be by far most beneficial to the patient and then to the system at the same time," Mercier concluded.

The findings of this study were published by the Journal of Surgical Research.

This report by the Canadian Press was first published in French on July 12, 2022.