Objectives: Patients who are found down (FD) with unknown mechanism of injury pose a triage dilemma. At the study institution, this population with suspicion of trauma were previously triaged as the highest-level trauma team activation (TTA). Due to high rates of over-triage, this criterion was modified to include signs of trauma. The purpose of this study is to compare injured FD patients to uninjured FD patients and identify patient characteristics and outcomes associated with injury.
Methods: A retrospective review was conducted on adult patients with the cause code “found down” between 1/2019—4/2021. Injured patients were compared to uninjured patients. Injury was defined as an injury severity score (ISS) of 1 or higher. The criteria for suspicion of trauma included altered mental status, confusion, seizures, intoxication, or dementia. Signs of trauma were defined as abrasions, lacerations, ecchymosis, contusions, hematomas, deformity, pain, and crepitus.
Results: 415 patients were identified during the study period with 273 (65.8%) sustaining injury and 142 (34.2%) were uninjured. There were no differences in age, gender, and arrival Glasgow Coma Scale (GCS) score. No differences were seen in arrival vital signs. Mean ISS of the injured patients was 5.4. 84.3% of the injured patients had an ISS 10 or less and 12.8% had an ISS greater than 15. The injured group was more likely to have signs of trauma (96.0% vs 17.6%, p< 0.0001) whereas the uninjured group was more likely to have suspicion of trauma (2.2% vs 62.7%, p< 0.0001). There was no difference in the rate of highest-level TTA between two groups. Patients who were injured had a higher rate of admission to the trauma service (40.3% vs 7.8%) and patients without injury had higher rates of discharge from the ED (28.6% vs 43.0%) and admission to the nonsurgical services (30.8% vs 47.9%) (p < 0.0001). The two groups had similar hospital length of stay (LOS). The injured group had a longer median ICU LOS (0 (0,1) vs 0 (0,0), p=0.033) and mortality rate (18.3% vs 8.5%, p=0.008). Independent predictors of mortality were DNR status and older age while dementia and higher GCS were protective.
Conclusion: Injured and uninjured FD trauma patients had similar arrival GCS and hemodynamic parameters, making it challenging to identify those with injury who require trauma evaluation. Signs of trauma can be a valuable indicator of injury in the FD population.
