Ryb Gabriel E, Dischinger Patricia C
Charles C. Mathias, Jr. National Study Center for Trauma and EMS, University of Maryland, Baltimore, Maryland 21201, USA.
J Trauma. 2011 Sep;71(3):742-7. doi: 10.1097/TA.0b013e31822ba010.
To evaluate whether older injured motor vehicular crash (MVC) occupants' access to trauma centers (TC) reflects the lower threshold suggested in triaging recommendations.
Adult front seat occupants of MVCs transported to a hospital from 1999 through 2006 included in the National Automotive Sampling System (NASS) were studied. Cases were classified by their age in years (≤60 years or >60 years). Younger and older injured MVC occupants were compared in relation to their likelihood of being transported to a TC. Multiple logistic regression models were built to adjust for confounders.
A total of 35,830 cases representing 7,894,940 cases after weighting were analyzed. Older occupants were less likely to be transported to a TC than younger ones (47% vs. 55%, p < 0.0001). Older individuals were more likely to be restrained, passengers, and seated on the impacted side of lateral crashes. Injury severity was higher among the older group (mean Injury Severity Score, 4.1 vs. 3.1; p < 0.0001) and so was the resulting mortality (1.7% vs. 0.6%, p < 0.0001). Multiple logistic regression models after adjusting for confounders (i.e., other triage criteria) revealed a lower likelihood of TC transport (odds ratio, 0.75 [0.57-0.98]) for the older group.
In contrast to the American College of Surgeons triaging recommendations, injured MVC occupants older than 60 years are less likely to be transported to a TC than their younger counterparts. Further studies should establish whether the lower access to TC experienced by the older population is a function of geographical factors, emergency medical services unconscious bias, or other factors.
评估老年机动车碰撞事故（MVC）受伤者前往创伤中心（TC）的情况是否符合分诊建议中提出的较低阈值。
研究对象为1999年至2006年期间被送往医院的国家汽车抽样系统（NASS）中的成年MVC前排乘客。病例按年龄（≤60岁或>60岁）分类。比较年轻和老年MVC受伤乘客被送往TC的可能性。建立多个逻辑回归模型以调整混杂因素。
共分析了35,830例病例，加权后代表7,894,940例病例。老年乘客被送往TC的可能性低于年轻乘客（47%对55%，p<0.0001）。老年人更有可能系安全带、是乘客且坐在侧面碰撞的受撞侧。老年组的损伤严重程度更高（平均损伤严重度评分，4.1对3.1；p<0.0001），死亡率也更高（1.7%对0.6%，p<0.0001）。调整混杂因素（即其他分诊标准）后的多个逻辑回归模型显示，老年组被送往TC的可能性较低（优势比，0.75[0.57 - 0.98]）。
与美国外科医师学会的分诊建议相反，60岁以上的MVC受伤乘客比年轻乘客被送往TC的可能性更小。进一步的研究应确定老年人群前往TC的机会较低是地理因素、紧急医疗服务无意识偏见还是其他因素的作用。
