An article appearing in the August issue of
Archives of
Surgery reports on potential unconscious age bias among
emergency medical services personnel: they are less likely to bring
elderly trauma patients to a trauma center compared to younger patients.
David C. Chang, Ph.D., M.P.H., M.B.A. (Johns Hopkins School of
Medicine and Johns Hopkins Bloomberg School of Public Health,
Baltimore) and colleagues note that by 2050, some 39% of all trauma
patients will be 65 years of age or older. They write: "Evidence-based
clinical practice guidelines strongly recommend that elderly trauma
patients be treated as aggressively as non-elderly patients...However,
some studies have suggested that age bias may still exist in trauma
care, even in the prehospital phase of that care."
With 10 years of data from the statewide Maryland Ambulance Information
System, the researchers presented findings to emergency medical
services (EMS) and trauma center personnel at EMS conferences and grand
rounds between 2004 and 2006. They then surveyed the EMS personnel to
further explore the issue. In the registry, there were 26,565 trauma
patients (those who met criteria set by the American College of
Surgeons (ACS) and were declared level I status - critically ill or
injured and requiring immediate attention - by EMS personnel).
Chang and colleagues found that 49.9% of patients older than 65 were
undertriaged - not taken to a state-designated trauma center - compared
to just 17.8% of younger patients. Statistical adjustment for
confounding factors revealed that being 65 years or older was linked to
a 52% less likelihood of being taken to a trauma center. Further, the
investigators note that the reduced likelihood begins at age 50 and
decreases again at age 70.
