This paper reminds us older patients have higher mortality and worse outcomes overall if their injury includes a head injury. Any mechanism that results in head injury, including fall from standing, has a higher potential for death, disability, and long term cognitive decline in older patients. Triaging these patients to trauma centers can lead to better outcomes. The difficulty is knowing which patients to send to trauma centers vs. emergency departments. The authors write:
"clinicians should consider transporting to a trauma center in geriatric patients with head trauma, if feasible. However, given the frequency with which head injury occurs, transportation to a trauma center for all patients with head trauma is likely to overwhelm EMS systems and hospitals. Unfortunately, the existing literature does not delineate the subset of patients whose condition will benefit from this evaluation . Given these considerations, we recommend EMS clinicians consider abnormal mental status, presence of anti-coagulation, and loss of consciousness as considerations to transport to a trauma center in cases where the need for trauma center evaluation is not clear.”
References
Haussner, W. K., Breyre, A. M., Bascombe, K., Barrett, W. J., Camacho, M. A., Overton-Harris, P., … Colwell, C. (2025). Prehospital Trauma Compendium: Management of Geriatric Trauma Patients – A Position Statement and Resource Document of NAEMSP. Prehospital Emergency Care, 1–10. https://doi.org/10.1080/10903127.2025.2557006
