Age-related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

作者：Flottemesch Thomas J; Raetzman Susan; Heslin Kevin C; Fingar Katie; Coffey Rosanna; Barrett Marguerite; Moy Ernest

来源：ACADEMIC EMERGENCY MEDICINE, 2017, 24(4): 447-457.

DOI：10.1111/acem.13150

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>In 2006, the American College of Surgeons’ Committee on Trauma and the Centers for Disease Control and Prevention released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or <jats:styled-content style="fixed-case">II</jats:styled-content> trauma center (<jats:styled-content style="fixed-case">TC</jats:styled-content>) were added in 2011, reflecting perceived undertriage to <jats:styled-content style="fixed-case">TC</jats:styled-content>s for older adults. We examined whether age‐based disparities in <jats:styled-content style="fixed-case">TC</jats:styled-content> care for severe head injury decreased following introduction of the 2011 revisions.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A pre‐post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases with multivariable logistic regressions considered changes in 1) the trauma designation of the emergency department where treatment was initiated and 2) transfer to a <jats:styled-content style="fixed-case">TC</jats:styled-content> following initial treatment at a non‐<jats:styled-content style="fixed-case">TC</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Compared with adults aged 18 to 44 years, after multivariable adjustment, in both years <jats:styled-content style="fixed-case">TC</jats:styled-content> care was less likely for adults aged 45 to 64 years (odds ratio [<jats:styled-content style="fixed-case">OR</jats:styled-content>] = 0.76 in 2009 and 0.74 in 2012), aged 65 to 84 years (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 0.61 and 0.59), and aged 85+ years (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 0.53 and 0.56). Between 2009 and 2012, the likelihood of <jats:styled-content style="fixed-case">TC</jats:styled-content> care increased for all age groups, with the largest increase among those aged 85+ years (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 1.18), which was statistically different (p = 0.02) from the increase among adults aged 18 to 44 years (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 1.12). The analysis of transfers yielded similar results.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Although patterns of increased <jats:styled-content style="fixed-case">TC</jats:styled-content> treatment for all groups with severe head trauma indicate improvements, age‐based disparities persisted.</jats:p></jats:sec>

• 出版日期2017-4