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2326 Does a novel ED triage tool for patients aged 65 and over who have fallen less than two metres identify the seriously injured older adult?
  1. Sarah Midgley1,
  2. Samuel Tan1,
  3. Simon Meredith2
  1. 1Royal Derby Hospital
  2. 2Lincoln County Hospital


Aims and Objectives The novel ED triage tool was developed after the authors found that 3 current triage tools for older adults injured by low level falls had very low specificity, resulting in significant over-triage. A Delphi study with experienced EM clinicians was subsequently carried out to create the novel tool. The triage tool utilised their responses.

The aim was to determine whether these criteria could be used to identify patients with serious injuries at the point of ED triage, and hopefully improve their care.

Method and Design A retrospective review of 250 consecutive patients attending an East Midlands Trauma Unit after a fall or collapse from a height of less than two metres was carried out. The notes were examined to assess whether the patient met triage criteria in the new triage tool.

The primary aim of the triage tool was to identify those with an Injury Severity Score of 9 or more.

The sensitivity and specificity of the novel triage tool was calculated. The performance of individual triage criteria was assessed to determine whether any were particularly discriminatory.

Results and Conclusion The triage tool did not reach the ideal levels of sensitivity and specificity. Of the 55 criteria identified by clinicians as requiring immediate assessment, a significant proportion were not met by any patient. Patients who fell with acute illnesses were more likely to have abnormal observations than those with serious injuries, making criteria reliant on abnormal observations less useful.

A combination of criteria such as pain in 2 body regions and reduced GCS was more predictive of serious injuries than a single criterion.

The criteria generated by the Delphi study may be able to identify over 65s at risk of serious injuries after low-level falls, but further refinement of the tool and a larger sample size will be required for retrospective validation.

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