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In a large retrospective study, researchers found that age bias may contribute to undertriaging of older trauma patients by emergency medical services (EMS) personnel. By definition, undertriaging occurred when trauma patients weren't transported to a designated trauma center. Trauma patients were defined as those meeting American College of Surgeons criteria and subjectively given priority I status by EMS personnel.


Analyzing records of 26,565 trauma patients, researchers found that undertriaging was significantly higher in patients age 65 and older than in younger patients (50% versus 18%). The decrease in trauma center transports started at age 50, and decreased again at age 70. In follow-up surveys of 166 EMS and trauma center personnel conducted as part of the study, researchers identified three reasons for undertriaging of older adults: inadequate training in geriatric care (25%), lack of familiarity with protocol (12%), and possible age bias (13%).


The researchers noted that even when EMS personnel correctly identify traumatic injury, they're significantly less likely to take an older adult to a designated trauma center, and age bias was one possible cause. They write, "It may be helpful to highlight the literature that now suggests that elderly trauma patients do in fact return to productive lives after their injury, which can eliminate the perception of futility of care that may be used consciously or subconsciously to justify age bias."




Chang DC, et al., Undertriage of elderly trauma patients to state-designated trauma centers, Archives of Surgery, August 2008.