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

Abstract

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 II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age-based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions. 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 TC following initial treatment at a non-TC. Compared with adults aged 18 to 44 years, after multivariable adjustment, in both years TC care was less likely for adults aged 45 to 64 years (odds ratio [OR]= 0.76 in 2009 and 0.74 in 2012), aged 65 to 84 years (OR= 0.61 and 0.59), and aged 85+ years (OR= 0.53 and 0.56). Between 2009 and 2012, the likelihood of TC care increased for all age groups, with the largest increase among those aged 85+ years (OR=1.18), which was statistically different (p=0.02) from the increase among adults aged 18 to 44 years (OR=1.12). The analysis of transfers yielded similar results. Although patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age-based disparities persisted.