Flottemesch Thomas J, Raetzman Susan, Heslin Kevin C, Fingar Katie, Coffey Rosanna, Barrett Marguerite, Moy Ernest
Truven Health Analytics, Ann Arbor, MI.
Agency for Healthcare Research and Quality, Rockville, MD.
Acad Emerg Med. 2017 Apr;24(4):447-457. doi: 10.1111/acem.13150. Epub 2017 Mar 17.
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.
2006年，美国外科医师学会创伤委员会和疾病控制与预防中心发布了针对老年人的现场分诊指南。2011年增加了直接转运至一级或二级创伤中心（TC）的其他考量因素，反映出认为老年人被分诊至创伤中心的情况不足。我们研究了2011年修订版指南推出后，严重颅脑损伤患者在创伤中心接受治疗时基于年龄的差异是否有所减少。
采用前后对照设计，分析2009年和2012年医疗费用与利用项目的州急诊科数据库和州住院数据库，并通过多变量逻辑回归分析1）开始治疗的急诊科的创伤指定情况，以及2）在非创伤中心接受初始治疗后转至创伤中心的情况的变化。
与18至44岁的成年人相比，经过多变量调整后，在这两年中，45至64岁的成年人接受创伤中心治疗的可能性较小（2009年优势比[OR]=0.76，2012年为0.74），65至84岁的成年人（OR=0.61和0.59），以及85岁及以上的成年人（OR=0.53和0.56）。2009年至2012年期间，所有年龄组接受创伤中心治疗的可能性均有所增加，其中85岁及以上年龄组的增幅最大（OR=1.18），与18至44岁成年人的增幅（OR=1.12）在统计学上存在差异（p=0.02）。转运分析得出了类似的结果。
尽管所有严重颅脑创伤组接受创伤中心治疗的模式有所改善，但基于年龄的差异仍然存在。
