Study Shows Bias Towards the Elderly Trauma Patients
A recent study conducted by researchers at Johns Hopkins University and the Bloomberg School of Public Health showed that elderly trauma patients are less likely to be taken to a trauma center after being injured.
The study looked at records from over 26,000 patients from the Maryland Ambulance Information System in a ten year period from 1995 through 2004, weighing factors for trauma defined by the American College of Surgeons, which included information on presenting physiology, injury pattern, and mechanism of injury, and were classified as priority I status—critically ill or injured and requiring immediate attention by EMS personnel.
The study showed that patients 65 and older were 52% less likely to be transported to trauma center than younger patients. All patients ages 50 and older had a significantly lower likelihood of being taken to a trauma center than younger patients. Those 50 to 69 were 33% less likely to be taken to a trauma center and those 70 and older were 55% less likely to be taken to a trauma center.
The researchers presented the findings to EMS and trauma center personnel and then surveyed 166 of them about possible reasons for the differences. They were asked to provide a percent weight to the various possible reasons that could have contributed to the disparity. The top three were as follows:
- Inadequate training in handling older trauma patients (25.3%)
- Transport to a trauma center not worth it because of age, which the researchers defined as age bias (13.4%)
- Unfamiliarity with triage protocol (12%)
“Survey results suggest that lack of training related to elderly trauma patients and unfamiliarity with protocol may be allowing unconscious bias to affect triage decisions and that this problem occurs among both EMS providers and medical personnel at the receiving trauma centers,” the researchers said.
A survey was also given to EMS and medical personnel as a means to help identify where the problem was with respect to the disparity. Among 166 respondents (127 EMS personnel and 32 medical personnel, with 7 respondents refusing to identify their training background) who completed the follow-up surveys, the leading 3 factors responsible for this undertriage were given as insufficient training for managing elderly patients (25.3%), lack of familiarity with the protocol (12%), and possible age bias (13.4%).
This study points clearly to the need for unified protocol and training with respect to triage. Coupled with this problem the study brought out is the apparent misuse and overuse of helicopter transport which has been questioned in light of recent deadly transport accidents. Studies also need to be done to bring clarity to the triage process with respect to air transport as well. One such small study showed an alarming rate of people transported by helicopter, treated and released that same day. Studies should be done in this area comparing municipal transport systems to for-profit systems, first to see if there is abuse within the for-profit systems out there, and second whether the triage process needs to be rethought with respect to air transport.
A good triage system is the first step in saving lives. Putting the responders resources to best use, being sure that all the right people get the treatment they need and deserve is key.
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