305500
Identification of an Optimal Scale to Detect High-risk Older Adult Traumatic Brain Injury Patients in the EMS Setting
Older adults have worse traumatic brain injury (TBI)-related outcomes than younger adults. Emergency medical services (EMS) identification of TBI patients who need transport to a trauma center can improve these outcomes. To enhance EMS triage, we sought to identify a scale or components of a scale that optimizes detection of high-risk older adult TBI patients.
Methods
We gathered a consensus panel of nine experts in geriatrics, emergency medicine, trauma, TBI, and EMS to evaluate existing scales used to identify TBI. The panel’s criteria for rating the scales included: EMS provider familiarity with scale components, feasibility of use with older adults, and evidence for their performance in the EMS setting. Using the nominal group technique, we collected evaluations of the scales and convened an in-person meeting to discuss of the evaluations and achieve consensus.
Results
We identified 15 scales for evaluation. After discussion, the panel identified the Simplified Motor Scale, GCS–Motor Component, and AVPU (alert, voice, pain, unresponsive) as the strongest scales but determined that none fulfill all EMS provider and patient needs. Instead, the panel concluded that a dichotomized decision scheme that includes domains of these top-rated scales – alertness and motor function – would best identify high-risk patients.
Conclusion
Existing scales to identify TBI are inadequate for detection of high-risk older adult TBI patients in the EMS setting. A newly developed scale, derived from elements of existing scales, has potential to guide EMS providers in receiving hospital selection. Further work is needed to determine the validity of this new scale.
Learning Areas:
Other professions or practice related to public healthProvision of health care to the public
Learning Objectives:
Explain the public health relevance of EMS triage to improving the health of the older adult TBI population.
Name the current scales available for detection of TBI.
Describe the limitations of the current scales used for detection of TBI among the older adult population and in the EMS setting.
Keyword(s): Emergency Medical Services, Traumatic Brain Injury
Qualified on the content I am responsible for because: I have participated in many research studies regarding traumatic brain injury and trauma triage. Among my interests are improving the identification of persons who have brain injury.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.