title: Should age be a factor to change from a level II to a level I trauma activation?
abstract: BACKGROUND
  Elderly trauma patients have a higher incidence of medical comorbidities when compared with their younger cohorts. Currently, the minimally accepted criteria established by the Committee on Trauma for the highest level of trauma activation (Level I) does not include age as a factor. Should patients older than 60 years with multiple injuries and/or a significant mechanism of injury be considered as part of the criteria for Level I activation? Would these patients benefit from a higher level of activation?
  
  
  METHODS
  The National Trauma Data Bank was queried for the period of January 1, 1999, to December 31, 2008, for all trauma patients and associated injury severity score (ISS). The data abstracted were based on age and ISS.
  
  
  RESULTS
  The National Trauma Data Bank contained 802,211 trauma patients. Seventy-nine percent were younger than 60 years, and 21% were older than 60 years. Our analysis shows that in all levels of injury, patients older than 60 years have an increased risk for morbidity and mortality. We found a threefold increase in morbidity and a fivefold increase in mortality among the older (age >60 years) population with a minor ISS. Elderly patients with a major ISS demonstrated a twofold increase in morbidity and a fourfold increase in mortality.
  
  
  CONCLUSIONS
  Patients with an ISS between 0 and 15 are often triaged to Level II activation. Our data would suggest that patients older than 60 years should be a criterion for the highest level of trauma activation.
authors.affiliation: Department of General Surgery, Methodist Health System, Dallas, Texas 75203, USA. vkshifflette@gmail.com
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Shifflette
authors.forename: Manuel
authors.initials: M
authors.lastname: Lorenzo
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Mangram
authors.forename: Michael S
authors.initials: MS
authors.lastname: Truitt
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Amos
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Dunn
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D006801:Humans; D015601:Injury Severity Score; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality; D055815:Young Adult