Disparity in prehospital scene time for geriatric trauma patients

Alexander J Ordoobadi; Gregory A Peters; Maggie L Westfal; Cassandra M Kelleher; David C Chang

doi:10.1016/j.amjsurg.2021.10.031

Disparity in prehospital scene time for geriatric trauma patients

Am J Surg. 2022 Jun;223(6):1200-1205. doi: 10.1016/j.amjsurg.2021.10.031. Epub 2021 Oct 27.

Authors

Alexander J Ordoobadi¹, Gregory A Peters², Maggie L Westfal³, Cassandra M Kelleher⁴, David C Chang⁵

Affiliations

¹ Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: aordoobadi@bwh.harvard.edu.
² Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: GPETERS3@mgh.harvard.edu.
³ Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: mwestfal@partners.org.
⁴ Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: CKELLEHER3@mgh.harvard.edu.
⁵ Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: dchang8@mgh.harvard.edu.

PMID: 34756693
DOI: 10.1016/j.amjsurg.2021.10.031

Abstract

Background: Geriatric patients face disparities in prehospital trauma care. We hypothesized that geriatric trauma patients are more likely to experience prolonged prehospital scene time than younger adults.

Methods: Retrospective analysis of the 2017 National Emergency Medical Services Information System. Patients who met anatomic or physiologic trauma criteria based on national triage guidelines were included (n = 16,356). Geriatric patients (age≥65, n = 3594) were compared to younger adults (age 18-64). The primary outcome was prolonged scene time (>10 min). Multivariable logistic regression was performed, controlling for patient demographics, on-scene treatments, and injury severity.

Results: Geriatric patients were more likely to experience prolonged scene time than younger adults after controlling for other factors (OR 1.78, 95% CI 1.57-2.04, p < 0.001). The likelihood of prolonged scene time reached OR 2.29 (95% CI 1.85-2.84) for patients age 70-79 and OR 2.66 (95% CI 2.07-3.42) for patients age 80-89, relative to age 18-29.

Conclusions: Geriatric trauma patients are more likely than younger adults to have prolonged prehospital scene time. This disparity may be caused by delayed recognition of injury severity or age-related cognitive biases.

Keywords: Disparities; Emergency medical services; Geriatric trauma; Scene time.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Emergency Medical Services*
Humans
Injury Severity Score
Middle Aged
Patients
Retrospective Studies
Trauma Centers
Triage
Wounds and Injuries* / therapy
Young Adult