Aims and Objectives Previous work carried out by the authors revealed that current triage tools for older trauma patients identified those with serious injuries, but specificity ranged from 11% - 31%, potentially resulting in significant levels of over-triage. The ideal triage tool should have an over-triage rate of under 35% with an under-triage rate of 5%.

Our aim was to develop a triage tool better able to discriminate between those seriously injured after low level falls and the minimally injured patient.

Method and Design An electronic three round Delphi study was designed to utilise the experience of triage nurses, and associate specialists and consultants in Emergency Medicine.

Participants initially listed criteria they use to determine whether a patient aged 65 and over who had fallen less than two metres required immediate assessment, assessment within 30 minutes or routine assessment. In subsequent rounds participants rated their agreement or disagreement with each criterion and if consensus was reached that criterion was accepted. If pre-determined consensus was not reached the criterion was discarded.

Results and Conclusion Twenty-nine clinicians completed three rounds of the study. A wide range of potential triage criteria were identified for this patient group. A total of 55 criteria reached consensus for immediate assessment, 16 for assessment at 30 minutes and 8 for routine assessment.

The Delphi study revealed that senior clinicians use multiple criteria to decide which older patients who have fallen are at risk of serious injuries. Such a large number of criteria mean the Delphi study has failed to immediately generate a triage tool for the older, low-energy trauma patient. Owing to the study design we were unable to reduce the number of criteria further.

Future work will focus on refining the criteria to aid development of a useable triage tool, especially as many immediate triage criteria are unlikely to be present in this patient group.