title: Increasing volume of patients at level I trauma centres: is there a need for triage modification in elderly patients with injuries of low severity?
abstract: BACKGROUND
  Since the introduction of a regionalized trauma system in Quebec in 1993, patient loads at level I trauma centres have been increasing gradually. We aimed to investigate the type of patient presenting to 4 tertiary trauma centres in Quebec, the nature of their injuries and whether there was a need to modify triage protocols.
  
  
  METHODS
  The study consisted of a review of major trauma patients entered into a regional trauma registry between Apr. 7, 1993, and Mar. 31, 2000. A total of 29 669 patients fulfilled the eligibility criteria. We compared patient demographics, injury type and severity and mechanism of injury.
  
  
  RESULTS
  During the 7 years of the study, there was an increase in the volume and presentation of patients injured in falls (p < 0.01), patients with extremity injuries (p < 0.01), single injuries (p < 0.01) and injuries to single body regions (p < 0.01). Young patients were mostly injured in motor vehicle collisions and had multiple injuries of high severity whereas elderly patients were mostly injured in falls and experienced isolated extremity injuries of low severity.
  
  
  CONCLUSIONS
  The proportion of elderly patients injured in falls, experiencing isolated extremity injuries of low severity and being treated at tertiary trauma centres in Quebec is overwhelmingly high. Revision of pre-hospital triage protocols should be considered and studied in order to transport trauma patients to appropriate facilities.
authors.affiliation: Department of Surgery, McGill University Health Centre-Montreal General Hospital, Montréal, Que. moisheliberman@sciopsis.com
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.forename: David S
authors.initials: DS
authors.lastname: Mulder
authors.forename: John S
authors.initials: JS
authors.lastname: Sampalis
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards; D017598:Efficiency, Organizational; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011792:Quebec / Q000453:epidemiology; D012041:Regional Medical Programs / Q000458:organization & administration; D012189:Retrospective Studies; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data* / Q000639:trends; D014218:Triage / Q000379:methods* / Q000592:standards; D014947:Wounds and Injuries / Q000145:classification* / Q000453:epidemiology* / Q000209:etiology