Disparities in Trauma Center Access of Older Injured Motor Vehicular Crash Occupants

Background: To evaluate whether older injured motor vehicular crash (MVC) occupants' access to trauma centers (TC) reflects the lower threshold suggested in triaging recommendations. Methods: Adult front seat occupants of MVCs transported to a hospital from 1999 through 2006 included in the National Automotive Sampling System (NASS) were studied. Cases were classified by their age in years (<= 60 years or >60 years). Younger and older injured MVC occupants were compared in relation to their likelihood of being transported to a TC. Multiple logistic regression models were built to adjust for confounders. Results: A total of 35,830 cases representing 7,894,940 cases after weighting were analyzed. Older occupants were less likely to be transported to a TC than younger ones (47% vs. 55%, p < 0.0001). Older individuals were more likely to be restrained, passengers, and seated on the impacted side of lateral crashes. Injury severity was higher among the older group (mean Injury Severity Score, 4.1 vs. 3.1; p < 0.0001) and so was the resulting mortality (1.7% vs. 0.6%, p < 0.0001). Multiple logistic regression models after adjusting for confounders (i.e., other triage criteria) revealed a lower likelihood of TC transport (odds ratio, 0.75 [0.57-0.98]) for the older group. Conclusion: In contrast to the American College of Surgeons triaging recommendations, injured MVC occupants older than 60 years are less likely to be transported to a TC than their younger counterparts. Further studies should establish whether the lower access to TC experienced by the older population is a function of geographical factors, emergency medical services unconscious bias, or other factors.