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| |  Emergency Care Personnel Demonstrate Age Bias in Trauma Patients CHICAGO -- August 18, 2008 -- Elderly trauma patients appear to be less likely than younger patients to be transported to a trauma centre, possibly because of unconscious age bias among emergency medical services (EMS) personnel, according to a report in the August issue of Archives of Surgery. "Evidence-based, clinical practice guidelines strongly recommend that elderly trauma patients be treated as aggressively as non-elderly patients," the authors wrote. "However, some studies have suggested that age bias may still exist in trauma care, even in the prehospital phase of that care." David C. Chang, PhD, Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and colleagues analysed 10 years of data from the statewide Maryland Ambulance Information System. The researchers also surveyed EMS and trauma centre personnel after presenting them with the registry findings at EMS conferences and grand rounds between 2004 and 2006. The registry identified 26,565 trauma patients, defined as those who met criteria set by the American College of Surgeons and declared level 1 status by EMS personnel. The study found that patients aged 65 years or older were more likely to be undertriaged or not taken to a state-designated trauma centre, compared with younger patients (49.9% vs 17.8%). After adjusting for other related factors, the researchers found that being 65 years or older was associated with a 52% reduction in likelihood of being transported to a trauma centre. This decrease in transports was found to start at age 50 years, with another decrease at age 70. A total of 166 individuals, including 127 EMS personnel and 32 medical personnel (14 attending physicians, 4 residents, 6 medical students, and 8 nurses), responded to the follow-up surveys. When asked about the most likely reasons for not transporting elderly patients to trauma centres, participants cited inadequate training for managing elderly patients (25.3%), unfamiliarity with protocol (12%), and possible age bias (13.4%) as the top 3 factors. "The problem of age bias raised in this study may negate efforts to improve clinical care for elderly trauma patients within trauma centres if the system as a whole does not function properly and deliver patients appropriately to needed resources," the authors wrote. "… It may be possible to address this problem without directly addressing age bias. A focus on retraining the providers about triage protocols may be sufficient." SOURCE: Journal of the American Medical Association
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