Background: The growth of the geriatric population, resulting in an exponential increase in the number of injured older people, determines the necessity of ensuring adequate access to specialized units such as trauma centers (TCs). The specificity of pathophysiological processes that progress with age, worsening the body's response to trauma, makes it difficult to develop an optimal triage protocol for geriatric patients, reducing high undertriage, i.e., underestimation of injuries and referral to lower-reference units. Aim: To verify the TC qualification criteria for 65+ patients and analyze the weights of individual triage factors for these patients. Methods: This was a retrospective analysis of the medical records of ED patients from the Clinical Hospital with TC in Poland admitted from 1.01.2017 to 31.12.2020. Among 155,320 ED patients, 6541 who formed Trauma group 65+ were selected, in which the TRISS score was estimated. The TC 65+ group meeting the currently applicable TC qualification criteria was selected. The TRISS cutoff value, TRISS 65+ group and TC-omitted 65+ group were determined. The significance of TC qualification factors was estimated. Receiver operating characteristic (ROC curve) analysis and multiple linear regression analysis were used for statistical classification. Results: The value of ≤ 88.84% determined the threshold for TC qualification, and the leakage of criteria was 58.51%. Six significant factors with different typing weights were identified: GCS ≤ 8 (− 42.90%), extensive crush injury of the extremities (− 33.74%), and RR < 10/min (− 16.16%), blunt injury to thoracic internal organs (− 13.75%), pelvic fracture (− 11.35%) and SBP ≤ 80 mmHg (− 10.41%) were performed. The weight + SD of each factor reduced the potential TRISSe value to ≤ 88.84% (threshold). Modifications of the cutoff values of significant physiological parameters were determined, i.e., GCS ≤ 14 (sensitivity = 79.79%, specificity = 98.25%, AUC = 0.896, Youden index = 0.780) and SBP ≤ 129 mmHg with questionable efficacy of the result. Conclusions: The current TC qualification criteria require modification for geriatric patients, which would complete the leakage estimated at 58.51% according to the TRISS scale. The leakage results from underestimation of the weight of the 6 triage factors to the TC, and the modification of the criteria should include a reduction in the current requirement of 4 factors to 1 and allow admission to the TC of a 65+ trauma patient with one of the following anatomical injuries: extensive crush injury of extremities, blunt injuries with symptoms of damage to internal thoracic organs, pelvic fracture, or one of the disorders of physiological parameters: GCS ≤ 8, RR < 10/min, or SBP ≤ 80 mmHg. In the other cases, the modification should also take into account the change in the GCS limit value to ≤ 14 (instead of ≤ 8) and the change in the SBP cutoff value from ≤ 80 mmHg to a higher one (but ≤ 129 mmHg) or the use of another factor. To complete the formula (undertriage according to ISS = 73.47%), additional factors, such as the mechanism of injury, must be included. It is necessary to develop research on the criteria for the qualification of geriatric patients to the TC, and the use of weight analysis of individual factors may contribute to the identification of properly balanced triage criteria.

Background: Standardized trauma assessment is essential for early clinical decision-making; however, it remains challenging in older adults because age-related physiological changes may obscure injury severity. Accurate triage is critical to ensure timely access to trauma centers (TCs). While triage decisions must rely on immediately available clinical findings, advanced trauma scoring systems are typically based on diagnostic data obtained later in the course of care. Although these tools are not suitable for real-time triage, they are established predictors of mortality and may provide an objective basis for evaluating TC qualification criteria. Because current national TC qualification criteria do not adequately account for age-specific factors, they may contribute to undertriage in older patients. This study aimed to retrospectively identify the trauma scoring system most suitable for evaluating TC qualification criteria in geriatric trauma patients. Methods: We conducted a retrospective cohort study of patients admitted to the emergency department of a single clinical hospital with a TC between 2017 and 2020. Among 155,320 ED admissions, 6,541 trauma patients aged ≥ 65 years were identified. Injury severity and physiological status were assessed using the coded Revised Trauma Score (RTSc), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS). A predefined subgroup of patients meeting national TC qualification criteria (TC group 65+) was analyzed separately. Predictive performance for in-hospital mortality was evaluated using receiver operating characteristic (ROC) curve analysis. Results: TRISS showed the highest discrimination for in-hospital mortality (AUC 0.888), followed by ISS (0.867) and RTSc (0.687). In the TC group 65+ , the mean TRISS-predicted survival probability was 34.58%, whereas observed in-hospital survival was 48.72%. The estimated undertriage rate was 73.47%, suggesting that current national TC qualification criteria may perform inadequately in older trauma patients. Conclusion: Current national TC qualification criteria may contribute to undertriage among older patients, potentially delaying access to advanced trauma care. Among the evaluated scoring systems, TRISS demonstrated the highest discriminatory performance for in-hospital mortality and appears to be the most suitable retrospective reference standard for assessing TC qualification criteria in geriatric trauma patients.

Aim: To analyze emergency department (ED) triage outcomes in geriatric trauma patients and evaluate undertriage in relation to injury severity. Methods: A retrospective analysis was conducted on anonymized medical records of patients aged ≥ 65 years admitted to the ED of the University Hospital in Kraków, Poland, due to trauma between 2018 and 2020. Among 111,615 total ED admissions, 4,922 geriatric trauma cases were identified. Triage categories (adapted ESI) were evaluated in relation to the Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), and Glasgow Coma Scale (GCS). Undertriage was defined as an ISS ≥ 16 with assignment to lower-risk triage priorities (3–5). Results: Undertriage occurred in 34.4% of severely injured geriatric patients, exceeding the recommended threshold of < 5%. Head and neck injuries were the most severe across triage categories (AIS 3–4). Among patients with head and neck injuries, those in the undertriage group 65 + had significantly higher GCS scores (median 15) than those in the correct triage group 65+ (median 5), suggesting that preserved consciousness may mask severe injuries. Overtriage was observed in 37.6% of cases, frequently involving head trauma with high GCS scores. Conclusions: These findings highlight the need for age-specific approaches to ED triage, particularly in cases of head trauma. In this cohort, commonly used physiological triage parameters, including the GCS, were associated with limitations in identifying patients with more severe injuries. These findings support further research on geriatric-specific triage approaches that account for age-related factors potentially affecting triage accuracy and the management of older trauma patients.

Introduction: This study characterizes patients with abdominal and/or pelvic trauma admitted to Emergency Departments (EDs) in Poland, focusing on differentiating stable from unstable cases. The objective is to inform of evidence-based guidelines for managing these injuries in both critical and non-critical trauma patients. Aim: The study aims to characterize patients admitted to randomly selected Hospital Emergency Departments in Poland after abdominal and/or pelvic injury. It aims to provide evidence-based recommendations for managing abdominal and pelvic trauma. Materials and methods: A retrospective analysis was conducted using anonymized medical records from three randomly selected EDs in Poland, representing Levels I, II, and III of the Polish Trauma Care System. Patients with abdominal and/ or pelvic trauma were identified and categorised by trauma type, injury mechanism, severity, and stability. Data were summarized using descriptive statistics, and relationships between variables were analyzed using the Chi-square or Fisher’s exact test, with α = 0.05 for significance. Results: Of 93,714 ED patients, 708 met the study criteria, with 215 confirmed cases of abdominal and/or pelvic trauma. Closed (blunt) injuries were predominant (96.3%), especially low-energy injuries among older adults. Mild trauma was most common (64.65%) according to the CRAMS scale, while severe injuries accounted for only 8.84%. A substantial proportion of patients were stable upon ED admission, with 69.3% of abdominal trauma and 100% of pelvic trauma patients exhibiting no signs of organ failure or peritoneal symptoms. The findings indicate a higher-than-expected prevalence of stable trauma cases, underscoring the need for guidelines to manage stable but potentially vulnerable patients. Discussion: This study offers insights into the demographic and clinical characteristics of patients with abdominal and/or pelvic trauma in EDs, with a particular focus on differentiating stable from unstable trauma patients and addressing distinct clinical needs. By testing key hypotheses on trauma type, severity, and patient stability, the study brings attention to areas in trauma management that may benefit from revised protocols and resource allocation. Our findings underscore the importance of recognizing stable trauma patients as a significant but underrepresented group in trauma literature. Existing studies are often conducted in EDs located within trauma centres, which influences the patient populations represented in the literature. Additionally, a common inclusion criterion in such studies is trauma team activation or the explicit identification of unstable patients with systolic blood pressure below 90 mmHg. Research focusing on stable patients with abdominal and/ or pelvic trauma is rare and typically addresses aspects other than the specific characteristics of this group. However, in our study, a substantial proportion of patients with abdominal and/or pelvic trauma were clinically stable upon ED arrival. This has implications for ED triage, where prioritization often leans towards critically unstable cases, potentially overlooking the nuanced needs of stable patients who may still benefit from close monitoring to prevent deterioration. Conclusions: This study reveals a significant proportion of stable, low-severity abdominal and pelvic trauma cases in Polish EDs, challenging the traditional focus on high-risk, unstable trauma. Recognizing stable patients’ specific needs could optimize triage and resource allocation, reducing unnecessary admissions while maintaining quality care. Future guidelines should integrate protocols for stable trauma cases to improve ED efficiency and patient outcomes. Significance: The findings of this study underscore the need for optimized resource allocation within EDs. Given the high proportion of clinically stable, low-severity trauma cases, current triage protocols may require adaptation to ensure efficient patient management. The current study provides evidence supporting the refinement of trauma protocols, particularly for geriatric trauma patients, whose stable presentations can be misleading. Additionally, research suggests that dedicated monitoring processes for stable trauma patients could reduce preventable complications, particularly in cases involving lowenergy blunt trauma. Expanding on existing assessment tools, including modified early warning scores (MEWS) and geriatric trauma triage criteria, could help differentiate stable but at-risk patients from those who can be safely discharged.