Seniors and women less likely to be transported to trauma centres
Survival rates higher than in hospitals
TORONTO If you’re an older woman seriously injured in an accident, chances are you’ll be taken by ambulance to the nearest hospital rather than a trauma centre where survival rates are much higher, says the trauma director at St. Michael’s Hospital.
“We know that there are disparities based on age and we know that there are disparities based on gender. So if you are an older female, you are not going to have similar access to care as a younger male,” says Dr. Avery Nathens, who also serves as director of the American College of Surgeons’ Trauma Quality Improvement Program.
In Ontario, severely injured elderly patients are about 30 per cent less likely to get trauma centre care. Females, in general, are about 10 per cent less likely to receive trauma centre care. These differences in access to care persist even after taking into consideration differences in types of injury one might see in old versus young and male versus female, he said.
Nathens is doing further research and hopes to have data published soon. But he said he has seen it firsthand and had his observations confirmed by assessing Ontario hospital data collected by the Canadian Institute for Health Information.
“We don’t know why that is but we do know that a trauma centre reduces the risk of death considerably after injury,” Nathens says. The trauma surgeon has a big interest in access to care and has created special program at Toronto’s St. Mike’s to improve trauma care for the elderly.
Of more than 150 hospitals in Ontario, 11 have trauma centres, including St. Mike’s and Hamilton General Hospital. The centres operate 24 hours with highly specialized staff and sophisticated diagnostic equipment. Some have helipads.
Previous research by Nathens found that going directly to a trauma centre, even if it means bypassing a closer hospital, results in a nearly 25 per cent lower death rate, as well as savings and improved quality of life for survivors.
When someone is severely injured, in a car accident or shooting for example, paramedics assess a patient and use field triage criteria in deciding whether to transport a patient to the nearest hospital or one with a trauma unit that could be further away. They look at vital signs, level of consciousness, broken bones, skin penetration and signs of spinal injury.
Curiously, age is also among the criteria.
“Age should be a modifying factor, which means that you may have a lesser injury but if you are older you should err on the side of going to a trauma centre,” Nathens says. “For some reason, we haven’t gotten there yet.”
If a trauma centre is too far away, a patient will be taken to a local hospital where an emergency physician can decide to have the patient airlifted to one if the injury is serious enough.
“The biases occur at both the level of the paramedic making decisions and also the doc who decides whether the patient will be transferred to a trauma centre,” Nathens says.
A 2008 study in the Archives of Surgery also found elderly patients are less likely to end up in trauma centres. Possible reasons included inadequate training, unfamiliarity with protocol and unconscious age bias.
Nathens is concerned about inadequate access to trauma centres and has found 62 per cent of seriously injured adults in Ontario are taken to their nearest hospital first and 69 per cent are never transferred to a trauma centre. Those who live farthest away from the centres get short shrift.
On Friday, he released results of a poll showing more than eight in 10 Ontarians would want to be taken directly to a trauma centre if they were seriously injured, even if another hospital were closer.
Nathens says access to trauma centres should be given more attention.
“It does seem odd that we monitor access times for elective surgery, but there is no means of monitoring access to trauma centre care where lives are at stake.”http://www.thespec.com/news/world/artic ... ma-centres