Abstract：
OBJECTIVE: The aim of this study was to investigate the association between patient age and guideline adherence for prehospital care in emergency medical services (EMS) for moderate to severe trauma.
METHODS: This was a retrospective observational study that used a nationwide EMS-based trauma database from 2016 to 2019. Adult trauma patients whose injury severity score was greater than or equal to nine were screened, and those with cardiac arrest or without outcome data were excluded. The enrolled patients were categorized into four groups according to patient age: young (<45 years), middle-aged (45-64 years), old (65-84 years), and very old (>84 years). The primary outcome was guideline adherence, which was defined as following all prehospital care components: airway management for level of consciousness below verbal response, oxygen supply for pulse oximetry under 94 %, intravenous fluid administration for systolic blood pressure under 90 mmHg, scene resuscitation time within 10 min, and transport to the trauma center or level 1 emergency department. Multivariable logistic regression was conducted to calculate the adjusted odds ratios (aORs) and 95 % confidence intervals (95 % CIs).
RESULTS: Among the 430,365 EMS-treated trauma patients, 38,580 patients were analyzed-9,573 (24.8 %) in the young group, 15,296 (39.7 %) in the middle-aged group, 9,562 (24.8 %) in the old group, and 4,149 (10.8 %) in the very old group. The main analysis revealed a lower probability of guideline adherence in the old group (aOR 95 % CI = 0.84 (0.76-0.94)) and very old group (aOR 95 % CI = 0.68 (0.58-0.81)) than in the young group.
CONCLUSIONS: We found disparities in guideline adherence for prehospital care according to patient age at the time of EMS assessment of moderate to severe trauma. Considering this disparity, the prehospital trauma triage and management for older patients needs to be improved and educated to EMS providers.
METHODS: This was a retrospective observational study that used a nationwide EMS-based trauma database from 2016 to 2019. Adult trauma patients whose injury severity score was greater than or equal to nine were screened, and those with cardiac arrest or without outcome data were excluded. The enrolled patients were categorized into four groups according to patient age: young (<45 years), middle-aged (45-64 years), old (65-84 years), and very old (>84 years). The primary outcome was guideline adherence, which was defined as following all prehospital care components: airway management for level of consciousness below verbal response, oxygen supply for pulse oximetry under 94 %, intravenous fluid administration for systolic blood pressure under 90 mmHg, scene resuscitation time within 10 min, and transport to the trauma center or level 1 emergency department. Multivariable logistic regression was conducted to calculate the adjusted odds ratios (aORs) and 95 % confidence intervals (95 % CIs).
RESULTS: Among the 430,365 EMS-treated trauma patients, 38,580 patients were analyzed-9,573 (24.8 %) in the young group, 15,296 (39.7 %) in the middle-aged group, 9,562 (24.8 %) in the old group, and 4,149 (10.8 %) in the very old group. The main analysis revealed a lower probability of guideline adherence in the old group (aOR 95 % CI = 0.84 (0.76-0.94)) and very old group (aOR 95 % CI = 0.68 (0.58-0.81)) than in the young group.
CONCLUSIONS: We found disparities in guideline adherence for prehospital care according to patient age at the time of EMS assessment of moderate to severe trauma. Considering this disparity, the prehospital trauma triage and management for older patients needs to be improved and educated to EMS providers.
摘要：
目的：本研究的目的是调查患者年龄与急诊医疗服务（EMS）中至重度创伤院前护理指南依从性之间的关系。
方法：这是一项回顾性观察性研究，使用了2016年至2019年基于EMS的全国性创伤数据库。筛选损伤严重度评分大于或等于9分的成人创伤患者,有心脏骤停或无结局数据的患者被排除.根据患者年龄将纳入的患者分为四组：年轻（<45岁），中年人（45-64岁），年龄（65-84岁），而且非常老（>84岁）。主要结果是指南依从性，定义为以下所有院前护理组成部分：意识水平低于口头反应的气道管理，脉搏血氧饱和度的氧气供应低于94%，收缩压低于90mmHg的静脉输液，10分钟内的现场复苏时间，并送往创伤中心或一级急诊科。进行多变量逻辑回归以计算调整比值比（aOR）和95％置信区间（95％CIs）。
结果：在430,365名经EMS治疗的创伤患者中，对38,580例患者进行了分析-年轻组的9,573例(24.8%)，中年组15,296(39.7%)，老年组9,562（24.8％），和4149（10.8%）在非常老的组。主要分析显示，老年组（aOR95％CI=0.84（0.76-0.94））和非常老年组（aOR95％CI=0.68（0.58-0.81））的指南依从性概率低于年轻组。
结论：我们发现，在对中度至重度创伤进行EMS评估时，根据患者年龄，院前护理的指南依从性存在差异。考虑到这种差距,老年患者的院前创伤分诊和管理需要改进,并向EMS提供者进行教育.
方法：这是一项回顾性观察性研究，使用了2016年至2019年基于EMS的全国性创伤数据库。筛选损伤严重度评分大于或等于9分的成人创伤患者,有心脏骤停或无结局数据的患者被排除.根据患者年龄将纳入的患者分为四组：年轻（<45岁），中年人（45-64岁），年龄（65-84岁），而且非常老（>84岁）。主要结果是指南依从性，定义为以下所有院前护理组成部分：意识水平低于口头反应的气道管理，脉搏血氧饱和度的氧气供应低于94%，收缩压低于90mmHg的静脉输液，10分钟内的现场复苏时间，并送往创伤中心或一级急诊科。进行多变量逻辑回归以计算调整比值比（aOR）和95％置信区间（95％CIs）。
结果：在430,365名经EMS治疗的创伤患者中，对38,580例患者进行了分析-年轻组的9,573例(24.8%)，中年组15,296(39.7%)，老年组9,562（24.8％），和4149（10.8%）在非常老的组。主要分析显示，老年组（aOR95％CI=0.84（0.76-0.94））和非常老年组（aOR95％CI=0.68（0.58-0.81））的指南依从性概率低于年轻组。
结论：我们发现，在对中度至重度创伤进行EMS评估时，根据患者年龄，院前护理的指南依从性存在差异。考虑到这种差距,老年患者的院前创伤分诊和管理需要改进,并向EMS提供者进行教育.
