Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth

Elizabeth Brown, Hideo Tohira, Paul Bailey, Daniel Fatovich, Gavin Pereira, Judith Finn

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To describe the characteristics and outcomes of older adult (≥65 years) major trauma patients in comparison with younger adults (16–64 years). To determine whether older age is associated with a reduced likelihood of transport (directly or indirectly) to a major trauma centre and whether this is associated with in-hospital mortality. Methods: A retrospective cohort study of major trauma patients transported to hospital by St John Ambulance paramedics in Perth, Western Australia, between 1 January 2013 and 31 December 2016. Multivariate logistic regression was used to test the relationship between age and major trauma centre transport. Multivariate logistic regression analysis using inverse probability of treatment weighting was used to determine if major trauma centre transport was associated with in-hospital mortality in older adults. Results: One thousand six hundred and twenty-five patients were included; of these 576 (35%) were ≥65 years. In comparison with younger adults, older adults had more falls as their mechanism of injury (n = 358 [62%] versus n = 102 [10%], P ≤ 0.001) and more major head injuries (n = 472 [82%] versus n = 609 [58%], P ≤ 0.001). Older adults had lower odds (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.35–0.78) of major trauma centre transport and this was associated with 1.7 times the likelihood of in-hospital mortality (95% CI 1.04–2.7). Conclusions: Older adults who were not transported to the trauma centre had an increased odds of in-hospital mortality. However, older age was associated with a significantly reduced likelihood of trauma centre transport. With the aging population, the development of specific prehospital triage criteria to enable the complexities of this higher-risk population to be identified is important.

Original languageEnglish
JournalEMA - Emergency Medicine Australasia
DOIs
Publication statusE-pub ahead of print - 3 Mar 2019

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Ambulances
Trauma Centers
Hospital Mortality
Wounds and Injuries
Young Adult
Logistic Models
Confidence Intervals
Allied Health Personnel
Western Australia
Triage
Craniocerebral Trauma
Population
Cohort Studies
Retrospective Studies
Odds Ratio
Regression Analysis

Cite this

@article{2004bdafed39493294e095d504156645,
title = "Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth",
abstract = "Objective: To describe the characteristics and outcomes of older adult (≥65 years) major trauma patients in comparison with younger adults (16–64 years). To determine whether older age is associated with a reduced likelihood of transport (directly or indirectly) to a major trauma centre and whether this is associated with in-hospital mortality. Methods: A retrospective cohort study of major trauma patients transported to hospital by St John Ambulance paramedics in Perth, Western Australia, between 1 January 2013 and 31 December 2016. Multivariate logistic regression was used to test the relationship between age and major trauma centre transport. Multivariate logistic regression analysis using inverse probability of treatment weighting was used to determine if major trauma centre transport was associated with in-hospital mortality in older adults. Results: One thousand six hundred and twenty-five patients were included; of these 576 (35{\%}) were ≥65 years. In comparison with younger adults, older adults had more falls as their mechanism of injury (n = 358 [62{\%}] versus n = 102 [10{\%}], P ≤ 0.001) and more major head injuries (n = 472 [82{\%}] versus n = 609 [58{\%}], P ≤ 0.001). Older adults had lower odds (adjusted odds ratio 0.52, 95{\%} confidence interval [CI] 0.35–0.78) of major trauma centre transport and this was associated with 1.7 times the likelihood of in-hospital mortality (95{\%} CI 1.04–2.7). Conclusions: Older adults who were not transported to the trauma centre had an increased odds of in-hospital mortality. However, older age was associated with a significantly reduced likelihood of trauma centre transport. With the aging population, the development of specific prehospital triage criteria to enable the complexities of this higher-risk population to be identified is important.",
keywords = "emergency medical services, major trauma, older adults, prehospital care",
author = "Elizabeth Brown and Hideo Tohira and Paul Bailey and Daniel Fatovich and Gavin Pereira and Judith Finn",
year = "2019",
month = "3",
day = "3",
doi = "10.1111/1742-6723.13244",
language = "English",
journal = "Emergency Medicine",
issn = "1742-6723",
publisher = "John Wiley & Sons",

}

TY - JOUR

T1 - Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth

AU - Brown, Elizabeth

AU - Tohira, Hideo

AU - Bailey, Paul

AU - Fatovich, Daniel

AU - Pereira, Gavin

AU - Finn, Judith

PY - 2019/3/3

Y1 - 2019/3/3

N2 - Objective: To describe the characteristics and outcomes of older adult (≥65 years) major trauma patients in comparison with younger adults (16–64 years). To determine whether older age is associated with a reduced likelihood of transport (directly or indirectly) to a major trauma centre and whether this is associated with in-hospital mortality. Methods: A retrospective cohort study of major trauma patients transported to hospital by St John Ambulance paramedics in Perth, Western Australia, between 1 January 2013 and 31 December 2016. Multivariate logistic regression was used to test the relationship between age and major trauma centre transport. Multivariate logistic regression analysis using inverse probability of treatment weighting was used to determine if major trauma centre transport was associated with in-hospital mortality in older adults. Results: One thousand six hundred and twenty-five patients were included; of these 576 (35%) were ≥65 years. In comparison with younger adults, older adults had more falls as their mechanism of injury (n = 358 [62%] versus n = 102 [10%], P ≤ 0.001) and more major head injuries (n = 472 [82%] versus n = 609 [58%], P ≤ 0.001). Older adults had lower odds (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.35–0.78) of major trauma centre transport and this was associated with 1.7 times the likelihood of in-hospital mortality (95% CI 1.04–2.7). Conclusions: Older adults who were not transported to the trauma centre had an increased odds of in-hospital mortality. However, older age was associated with a significantly reduced likelihood of trauma centre transport. With the aging population, the development of specific prehospital triage criteria to enable the complexities of this higher-risk population to be identified is important.

AB - Objective: To describe the characteristics and outcomes of older adult (≥65 years) major trauma patients in comparison with younger adults (16–64 years). To determine whether older age is associated with a reduced likelihood of transport (directly or indirectly) to a major trauma centre and whether this is associated with in-hospital mortality. Methods: A retrospective cohort study of major trauma patients transported to hospital by St John Ambulance paramedics in Perth, Western Australia, between 1 January 2013 and 31 December 2016. Multivariate logistic regression was used to test the relationship between age and major trauma centre transport. Multivariate logistic regression analysis using inverse probability of treatment weighting was used to determine if major trauma centre transport was associated with in-hospital mortality in older adults. Results: One thousand six hundred and twenty-five patients were included; of these 576 (35%) were ≥65 years. In comparison with younger adults, older adults had more falls as their mechanism of injury (n = 358 [62%] versus n = 102 [10%], P ≤ 0.001) and more major head injuries (n = 472 [82%] versus n = 609 [58%], P ≤ 0.001). Older adults had lower odds (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.35–0.78) of major trauma centre transport and this was associated with 1.7 times the likelihood of in-hospital mortality (95% CI 1.04–2.7). Conclusions: Older adults who were not transported to the trauma centre had an increased odds of in-hospital mortality. However, older age was associated with a significantly reduced likelihood of trauma centre transport. With the aging population, the development of specific prehospital triage criteria to enable the complexities of this higher-risk population to be identified is important.

KW - emergency medical services

KW - major trauma

KW - older adults

KW - prehospital care

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U2 - 10.1111/1742-6723.13244

DO - 10.1111/1742-6723.13244

M3 - Article

JO - Emergency Medicine

JF - Emergency Medicine

SN - 1742-6723

ER -