Disparity in guideline adherence for prehospital care according to patient age in emergency medical service transport for moderate to severe trauma

Objectives 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 minutes, 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. Conclusion 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.