Table 4 Trauma care interventions for older adults in ED, by level of evidence

Trauma care interventions to improve system performance

Callahan et al., 2020, USA [104]

Received trauma activation, %

19.9

74.9

 < 0.001*

III-2

 + 

Percentage discharged directly home without injury

4.3

44

 < 0.001*

 + 

Critical ED disposition and failed to receive trauma activation, %

65.1

23.5

 < 0.001*

 + 

Traumatic intracranial haemorrhage and failed to receive a trauma activation, %

70.7

27.3

 < 0.001*

 + 

Hospital LOS (days), mean (SD)

1.5 (1.4)

1.4 (0.8)

0.03*

 + 

Mortality, n (%)

11/43 (4.3)

11/398 (2.0)

0.21

ne

Carr et al., 2018, USA [103]

Mortality (≥ 77 years old), OR (95% CI)

0.53 (0.3, 0.87)

NR

III-2

 + 

Hospital LOS (≥ 78 years old), regression coefficient (95% CI)

 − 0.55 (− 1.09, − 0.01

NR

 + 

Fernandez et al., 2019, US [102]

ED LOS (minutes), mean (SD)

451.5 (376.1)

364.6 (277.9)

 < 0.01*

III-2

 + 

Hospital LOS (days), median (SD)

5.2 (4.5)

4.5 (3.4)

 < 0.001*

 + 

Ventilator days, median (SD)

0.2 (1.2)

0.1 (1.0)

 < 0.001*

 + 

Time to physician evaluation (minutes), mean (SD)

61.7 (87.4)

42.2 (67.0)

 < 0.01*

 + 

Time to computed tomography (minutes), mean (SD)

212.9 (661.5)

161.3 (550.9)

 < 0.01*

 + 

Mortality, n (%)

28/749 (3.7%)

39/1,454 (2.7%)

0.15

ne

Hammer et al., 2016, US [101]

ED LOS ≤ 2 h, n (%)

61 (4.8)

65 (6.5)

0.08

III-2

ne

ED LOS > 2 h, n (%)

1,210 (95.2)

933 (93.5)

0.08

ne

Mortality, n (%)

105 (8.3)

76 (7.6)

0.57

ne

Pelaez et al., 2021, USA [96]

Time between ED arrival to provider at bed (minutes), median (IQR)

0 (0, 3)

7 (2, 11)

 < 0.001*

III-2

 + 

Provider to bedside within 30 min of arrival, n (%)

73/91 (80)

121/142 (85)

0.32

ne

Time between arrival to INR result (minutes), median (IQR)

38 (33, 48)

57 (40, 76)

 < 0.001*

 + 

Time between arrival and CT report (minutes), median (IQR)

52 (39, 61)

57 (43, 82)

0.01*

-

Time between CT report and reversal intervention (minutes), median (IQR)

49 (-12, 213)

118 (29, 165)

0.51

ne

Time between ED arrival to ED discharge (minutes), median (IQR)

147 (105,198)

120 (89,153)

0.01*

 + 

Time between ED arrival to hospital admissions (minutes), median (IQR)

108 (83,167)

179 (135,275),

 < 0.001*

-

ED disposition to home, n (%)

44/91 (48)

96/142 (68)

 < 0.01*

 + 

Admitted to hospital by trauma service, n (%)

36/91 (82)

12/142 (13)

 < 0.001

 + 

Sustained injury, n (%)

27/91 (30)

33/142 (23)

0.27

ne

Received reversal intervention, n (%)

5/91 (6)

15/142 (11)

0.39

ne

Mortality, n (%)

1/91 (1)

3/142 (2)

0.56

ne

Rittenhouse et al., 2015, USA [95]

Time from ED arrival to international normalised ratio test (minutes), median (IQR)

80 (57, 113)

13 (6, 27)

 < 0.001*

III-2

 + 

Time from ED arrival to head CT, median (IQR)

65 (42, 97)

35 (26, 48)

 < 0.001*

 + 

Patients discharged from ED, n (%)

76/337 (22.6)

233/415 (56.1)

NR

 + 

Time in ED (hours), median (IQR)

3.4 (2.5, 4.6)

2.6 (1.9, 3.4)

 < 0.001*

-

Patients admitted to hospital, n (%)

261/337 (77.4)

182/415 (43.9)

NR

 + 

Time from ED arrival to definitive care (hours), median (IQR)

2.6 (1.9, 3.6)

2.3 (1.7, 3.6)

0.34

ne

LOS (days), median (IQR)

5.0 (3.0, 8.1)

3.7 (1.8, 6.7)

 < 0.001*

 + 

Stable on discharge, n (%)

324/337 (96.1)

406/415 (97.8)

0.17

ne

Discharged to hospice, n (%)

7/337 (2.1)

5/415 (1.2)

0.34

ne

Mortality, n (%)

6/337 (1.8)

4/415 (1.0)

0.33

ne

Travers et al., 2021, USA [94]

Time from patient arrival in the ED to CT (hours), mean (SD)

2.4 (0.7)

0.6 (0.4)

 < 0.001*

III-2

 + 

ED LOS (hours), mean (SD)

4.7 (1.9)

2.6 (1.4)

 < 0.001*

 + 

Hospital LOS (days), mean (SD)

6.3 (4.5)

5.0 (4.4)

0.36

ne

Mortality, n (%)

0 (0.0)

2 (3.6%)

0.94

ne

van der Zwaard et al., 2020, The Netherlands [98]

Decided not to undergo surgery, n (%)

5/185 (2.7)

18/ 197 (9.1)

 < 0.01*

III-2

 + 

Wallace et al., 2019, US [97]

ED LOS (hours), mean (SD)

6.8 (2.9)

3.8 (2.4)

 < 0.001*

III-2

 + 

Hospital LOS (days), mean (SD)

7.4 (6.7)

5.0 (3.5)

 < 0.01*

 + 

Complications, n (%)

24/80 (30)

19/191 (10)

 < 0.001*

 + 

Mortality, n (%)

5 (6.3)

9 (4.7)

0.6

ne

Wiles et al., 2018, US [100]

ED LOS, hours

5.8

4.5

 < 0.01*

III-2

 + 

Hospital LOS, days

4.4

4.8

0.02*

-

Time from ED to admission to operating room

NR

NR

0.1

ne

Hospital admission, %

98.4

61.9

NR

 + 

Admission to skilled nursing facility/ inpatient rehabilitation, %

76.7

18.4

NR

 + 

Mortality, %

1.6

4.8

NR

-

Complications, %

16.4

1.6

 < 0.01*

 + 

Wright et al., 2014, UK [99]

Same-day discharge, OR (95% CI)

1.4 (1.2, 1.6)

 < 0.001*

III-2

 + 

Hospital LOS reduction, % (days)

18.2 (1.7)

 < 0.001*

 + 

Keyes et al., 2019, USA [105]

Diagnosed with intracranial haemorrhage on initial CT, n (%)

35/38 (92.1)

III-3

 + 

Diagnosed with intracranial haemorrhage on repeat CT, n (%)

3/38 (0.8)

 + 

Anticoagulation reversal protocol ordered, n (%)

29/38 (76.3)

Arrival to anticoagulation reversal protocol (minutes), mean (SD)

67.4 (27.6)