Does Prehospital Treatment of Significantly Injured Trauma Patients Vary by Age?

Introduction—Research has explored the frequency and success of attempted interventions within patient age groups. Yet available research fails to compare attempted interventions between patient age groups who have a similar acuity. Additional research is needed to compare interventions used among patient age groups.

Objectives—To determine the frequency with which prehospital providers attempt interventions in significantly injured trauma patients across all age groups.

Methods—A retrospective observational study of trauma patients was conducted using the North Carolina Prehospital Reporting System (PreMIS) data from July 1, 2012, to Dec. 31, 2012. Inclusion criteria consisted of patients with a Glasgow Coma Score of 10 or less. Trauma patients were divided into adult (17–65 years), pediatric (0–16 years), and geriatric (65 years or more). Logistic regressions were used to calculate the odds ratios for advanced airway and vascular access attempts controlling for specified age groups, gender, minority status, and patient acuity as determined by GCS and the revised trauma score. Additionally, a linear regression was used to determine the effects of age groups, gender, minority status, and acuity on total prehospital on-scene time.

Results—A total of 1,192 patients met the inclusion criteria, of which 888 (74.6%) were adult, 53 (4.4%) pediatric, and 250 (21%) geriatric. Advanced airway attempts were not statistically significant for pediatric or geriatric patients when compared to adults. Vascular access attempts were less likely in geriatric patients (OR 0.40, p=0.00). Males were more likely to receive an advanced airway (OR 2.12, p=0.00) or vascular access attempt (OR 1.34, p=0.04). Minorities were less likely to receive a vascular access attempt (OR 0.61, p=0.01). As GCS and RTS scores increased, the airway (OR 0.81, p=0.00; OR 0.71, p=0.00) attempts decreased. As GCS scores increased, the vascular access (OR 0.91, p=0.01) attempts decreased. Age, gender, and RTS were nonsignificant for total on-scene time. EMS personnel spent less time on scene with minorities (β=-2.12, p=0.04).

Conclusion—This study found disparities in procedure attempts in the geriatric population and on-scene times among minorities. Additional investigation is warranted to determine the rationale for these disparities.