Undertriage of geriatric trauma patients in the emergency department: A retrospective single-center study

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.