{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:46:29Z","timestamp":1791963989506,"version":"4.3.4"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Older adults are at increased risk of adverse outcomes after trauma but are frequently undertriaged because age\u2010related physiological changes may mask injury severity. We evaluated the performance of our institutional trauma team activation (TTA) criteria in patients aged \u2265 65\u00a0years within a developing trauma system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study using a trauma registry at a tertiary referral hospital in Malaysia between July 2024 and December 2025. Consecutive trauma patients aged \u2265 65\u00a0years admitted to the trauma surgery unit were included. Patients were stratified according to TTA status. Severe injury was defined as an Injury Severity Score (ISS)\u00a0&gt;\u00a015. The primary outcomes were TTA sensitivity, specificity, and undertriage. Secondary outcomes included mortality, intensive care unit (ICU) admission, and operative intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 114 geriatric trauma patients were included, of whom 59 (51.8%) sustained severe injury (ISS &gt; 15). TTA was activated in 17 patients (14.9%). The institutional TTA criteria demonstrated a sensitivity of 28.8% and specificity of 100%, with an undertriage rate of 43.3% and no overtriage. Overall in\u2010hospital mortality was 14.0% (16\/114) and was higher among patients undergoing TTA (64.7% vs. 5.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), reflecting greater injury severity. Severe traumatic brain injury accounted for 68.8% of deaths, and five of the sixteen deaths (31.3%) occurred in patients who did not meet TTA criteria.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Current TTA criteria demonstrated low sensitivity for identifying severely injured geriatric trauma patients, resulting in substantial undertriage despite excellent specificity. Missed patients frequently sustained severe traumatic brain injury without meeting existing activation criteria. These findings support prospective evaluation of geriatric\u2010specific modifications to trauma triage, including age\u2010adjusted physiological thresholds and lower thresholds for trauma team activation in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70551","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:26:39Z","timestamp":1787721999000},"page":"3111-3118","source":"Crossref","is-referenced-by-count":0,"title":["High Undertriage in Geriatric Trauma in a Developing Trauma System: Implications for Trauma Team Activation Criteria"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6782-9556","authenticated-orcid":false,"given":"Muhamad Izwan","family":"Ismail","sequence":"first","affiliation":[{"name":"Department of Surgery Hospital Tuanku Ja'afar Seremban  Seremban Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Japsimranjit","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital Tuanku Ja'afar Seremban  Seremban Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rizasohaini","family":"Baseri","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital Tuanku Ja'afar Seremban  Seremban Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norfarizan","family":"Azmi","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital Tuanku Ja'afar Seremban  Seremban Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742\u20106723.70226"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.4235\/agmr.25.0124"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12245\u2010025\u201001046\u20104"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049\u2010025\u201001465\u20105"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068\u2010025\u201002817\u20107"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049\u2010025\u201001432\u20100"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41999\u2010021\u201000512\u20105"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2019.04.003"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010024\u201000537\u20108"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003134820951450"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102168.2002.02210.x"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco\u20102018\u2010000282"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70551","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70551","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70551","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:03:21Z","timestamp":1791961401000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70551"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":12,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/wjs.70551"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70551","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]}}}