Undertriage of elderly trauma patients to state-designated trauma centers
Undertriage of elderly trauma patients to state-designated trauma centers
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DOI：
10.1001/archsurg.143.8.776
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发表时间：
2008-08-01
影响因子：
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通讯作者：
MacKenzie, Ellen J.
中科院分区：
文献类型：
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作者：
Chang, David C.;Bass, Robert R.;MacKenzie, Ellen J.
目的：确定年龄偏差是否是分诊错误的一个因素。设计：对全马里兰州救护车信息系统中前瞻性收集的 10 年数据（19952004 年）进行回顾性分析，然后分别对区域 EMS 会议和一级创伤中心的紧急医疗服务 (EMS) 和创伤中心人员进行调查。患者：创伤患者被定义为符合美国外科医生学会生理学、损伤和/或机制标准并主观宣布优先的患者I 状态由 EMS 人员确定。主要结果测量：分类不足，定义为创伤患者没有被运送到国家指定的创伤中心。结果：登记分析确定了 26 565 名创伤患者。 65 岁或以上患者的分类不足率显着高于年轻患者（49.9% vs 17.8%，P < .001）。多变量分析发现，与 50 岁以下的患者相比，创伤中心转运的减少从 50 岁开始（优势比，0.67；95% 置信区间，0.57-0.77），70 岁时再次下降（优势比，0.45；95% 置信区间，0.39-0.53）。共有 166 名受访者参与了后续调查，并将导致分类不足的前 3 个原因列为培训不足、不熟悉方案以及可能的年龄偏见。 结论：即使创伤得到了 EMS 的认可和承认，医疗服务提供者也始终不太可能考虑将老年患者送往创伤中心。现场急救人员和接收创伤中心人员的无意识年龄偏见被认为是一个可能的原因。
Objective: To determine whether age bias is a factor in triage errors.Design: Retrospective analysis of 10 years (19952004) of prospectively collected data in the statewide Maryland Ambulance Information System followed by surveys of emergency medical services (EMS) and trauma center personnel at regional EMS conferences and level I trauma centers, respectively.Patients: Trauma patients were defined as those who met American College of Surgeons physiology, injury, and/or mechanism criteria and were subjectively declared priority I status by EMS personnel.Main Outcome Measure: Undertriage, defined as when trauma patients were not transported to a state-designated trauma center.Results: The registry analysis identified 26 565 trauma patients. The undertriage rate was significantly higher in patients aged 65 years or older than in younger patients (49.9% vs 17.8%, P < .001). On multivariate analysis, this decrease in trauma center transports was found to start at age 50 years (odds ratio, 0.67; 95% confidence interval, 0.57-0.77), with another decrease at age 70 years (odds ratio, 0.45; 95% confidence interval, 0.39-0.53) compared with patients younger than 50 years. A total of 166 respondents participated in the follow-up surveys and ranked the top 3 causal factors for this undertriage as inadequate training, unfamiliarity with protocol, and possible age bias.Conclusions: Even when trauma is recognized and acknowledged by EMS, providers are consistently less likely to consider transporting elderly patients to a trauma center. Unconscious age bias, in both EMS in the field and receiving trauma center personnel, was identified as a possible cause.