Effect of Advanced Patient Age on EMS Provider Clinical Judgment in the Field Triage of Injured Patients

Background

The Field Triage Decision Scheme includes advanced age (≥55) as a special consideration in the prehospital triage of injured patients. Despite this, older adults are more likely to be undertriaged to non-trauma centers compared to younger adults.

Methods

We conducted a factorial survey with emergency medical services (EMS) providers. A standard vignette was created in which a hypothetical patient was described and subjects made two clinical judgments: 1) transportation to a trauma center (yes vs. no); and 2) importance of trauma center care to the patient’s clinical outcome (9-point Likert scale).  Levels of important characteristics related to the patient’s clinical presentation (e.g., age, systolic blood pressure, anatomic injuries, mechanism, etc.) were identified and randomly inserted into each vignette. Generalized estimating equations were used to estimate the effect of older age (≥55 vs. <55) on each clinical judgment.

Results

Data from 1898 vignettes, completed by 633 unique EMS providers, were analyzed. There was not a statistically significant association with older age (≥ 55 years) and decision to transport to a trauma center (AOR: 1.09; 95% CI: 0.88, 1.34) or perceived importance of trauma center care to a patient’s clinical outcome (Aβ: 0.12; 95% CI: -0.04, 0.29). Results were similar when age was divided into 10-year age strata.

Conclusion

Results in our sample suggest that older age does not influence EMS providers’ judgment, which may contribute to age-based disparities in field triage. Future studies should evaluate EMS decision processes and whether age-specific criteria improve triage accuracy for this vulnerable patient population.