Patients older than 65 are much less likely to be taken to a Maryland trauma center than younger patients with the same medical emergencies, according to a new report by Johns Hopkins researchers. And unconscious age bias could be a factor in the disparity, the researchers said.
The study, published yesterday in the journal Archives of Surgery, sought to quantify a question that has been explored anecdotally: Are elderly trauma patients treated with the same vigor as their younger counterparts? In short, the study found, they are not.
Researchers from the Johns Hopkins Schools of Medicine and Bloomberg School of Public Health analyzed data of about 26,000 trauma patients statewide from 1995 through 2004. Using data from the Maryland Ambulance Information System, the researchers compared the treatment of patients with similar medical trauma. Then they interviewed 166 emergency medical and trauma center personnel. The study found that 50 percent of patients 65 and older were not taken to trauma centers as opposed to 18 percent of younger patients. While the disparity was notable for patients 65 and older, researchers found that it began at age 50.
In interviews, EMS and medical professionals mentioned lack of training, unfamiliarity with transportation protocol and possible age bias as the biggest factors for the disparity.
"We use the word bias in certain areas of our study. But we also talk about blind spots," said Dr. David C. Chang, an instructor of surgery at the medical school and the study's lead author. "People are operating on assumptions of what old is and what elderly patients need."
State emergency medical officials said they have been providing more training to combat the problem.
Robert R. Bass, executive director of the Maryland Institute for Emergency Medical Services, which manages statewide emergency medical services, helped analyze the data for the report. He said the agency first became aware of disparities after similar data were published a decade ago.
"We were surprised that this was a recurrence of something we saw in the late 1990s. ... This is something we have to revisit periodically," he said. "And we want to share it with other states and EMS systems because if it's happening in Maryland, it's likely happening everywhere."
In fact, in the past year, the agency included age as a factor in its guidelines for determining when to take patients to trauma centers. The change was advised by the American College of Surgeons' Committee on Trauma.
