Newgard et al studied field triage of elderly patients with trauma. The use of additional factors can improve sensitivity but with a loss of specificity. The authors are from Oregon Health & Science University and University of Washington in Seattle.
Patient selection: injured patient >= 65 years of age
Outcome: ISS >= 16 or need for major non-orthopedic surgery
Standard field triage criteria (detects only about a third of patients with outcome)
(1) ISS >= 16
(2) major non-orthopedic surgery required
(3) head AIS >= 3
(4) chest AIS >= 3
(5) abdominopelvic AIS >= 3
Glasgow coma scale and vital signs (Newgard, 2014)
(1) GCS <= 14
(2) systolic blood pressure <= 110 or >= 200 mm Hg
(3) breathing rate <= 10 or >= 24 breaths per minute
(4) heart rate <= 60 or >= 110 beats per minute
Additional findings:
(1) comorbidities from the Charlson comorbidity index >= 2 (myocardial infarction, ulcer, cancer, congestive heart failure, stroke, dementia, diabetes, hepatic failure, paralysis, pulmonary dysfunction, renal insufficiency, rheumatic arthritis (connective tissue disease), vascular disease)
If 1 or more of these findings are present, then the patient is considered high risk.
Oral anticoagulant use could be used in place of comorbidities.
