Older Patients Less Likely to Be Taken to Trauma Centers

MONDAY, Aug. 18 (HealthDay News) -- Older trauma patients are less likely to be transported to an official trauma center for immediate care than younger patients, a new study found.

The finding was based on a review of a decade's worth of Maryland's statewide emergency medical services (EMS) records. And it suggests that the difference in care first comes into play as patients reach age 50 and worsens again at age 70.

"I'm not sure I would call it a bias, because that word has negative connotations, but in general, people do seem to have unconscious blind spots when it comes to the elderly," said study lead author David Chang. He is an assistant professor in the department of surgery at Johns Hopkins School of Medicine and in the department of health policy and management at Johns Hopkins Bloomberg School of Public Health.

---

---

"So not only EMS staff but also those receiving patients at trauma centers are operating on subjective assumptions as to what elderly patients need, how aggressively they should be treated, and what hospitals can do for them, rather than on clear and standard protocol, codes and trauma recommendations," Chang added. "And as a result, as patients get older, they are less likely to get into a trauma center."

Chang and his team reported their findings in the August issue of the Archives of Surgery.

The findings are based on an analysis of Maryland Ambulance Information System (MAIS) statewide records from 1995 through 2004. From the database, the study authors focused on 26,565 critically injured patients who experienced major trauma requiring immediate attention (so-called "Level I" patients), with the potential to be transported to one of Maryland's officially designated trauma centers.

The researchers found that about 18 percent of trauma patients under the age of 65 were "under-triaged," or not taken to a trauma center. Conversely, almost 50 percent of patients over the age of 65 were similarly undertreated.

A follow-up survey of 127 EMS workers and 32 medical personnel (including doctors, nurses, and medical students) revealed that the top three reasons for not transporting an older patient to a trauma center were: a lack of sufficient training for handling such patients (more than 25 percent); not knowing trauma protocols (12 percent); and potential age bias (just over 13 percent).