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Peer-reviewedCC BY 4.0Aging Clinical and Experimental Research

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

  • Małgorzata Sulej-Niemiec1
  • Andrzej Kopta1
  • Justyna Mazur1
  • Monika Bednarek-Chałuda2
  • Aleksandra Załustowicz3
  • Paweł Kukla1
  • Agnieszka Micek4
4 affiliations
  1. 1Faculty of Health Sciences, Department of Emergency Medical Services, Jagiellonian University Medical College, Michałowskiego St. 12, 31-126, Kraków, Poland
  2. 2Centre of Innovative Medical Education, Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
  3. 3Faculty of Medicine, Department of Orthopedics, Jagiellonian University Medical College, Kraków, Poland
  4. 4Faculty of Health Sciences, Institute of Nursing and Midwifery, Statistical Laboratory, Jagiellonian University Medical College, Kraków, Poland
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{sulejniemiec2026undertriage,
  title = {{Undertriage of geriatric trauma patients in the emergency department: A retrospective single-center study}},
  author = {Małgorzata Sulej-Niemiec and Andrzej Kopta and Justyna Mazur and Monika Bednarek-Chałuda and Aleksandra Załustowicz and Paweł Kukla and Agnieszka Micek},
  journal = {Aging Clinical and Experimental Research},
  year = {2026},
  month = aug,
  doi = {10.1007/s40520-026-03465-6},
  url = {https://doi.org/10.1007/s40520-026-03465-6},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Undertriage of geriatric trauma patients in the emergency department: A retrospective single-center study
AU  - Małgorzata Sulej-Niemiec
AU  - Andrzej Kopta
AU  - Justyna Mazur
AU  - Monika Bednarek-Chałuda
AU  - Aleksandra Załustowicz
AU  - Paweł Kukla
AU  - Agnieszka Micek
PY  - 2026
DA  - 2026/08/06
JO  - Aging Clinical and Experimental Research
DO  - 10.1007/s40520-026-03465-6
UR  - https://doi.org/10.1007/s40520-026-03465-6
AB  - 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.
SN  - 1594-0667
SN  - 1720-8319
ER  -