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January 19, 2009

Undertriage of Elderly Trauma Patients to State-Designated Trauma Centers: The Authors’ Response

Arch Surg. 2009;144(1):91. doi:10.1001/archsurg.2008.521

We thank Dr Mullins for his insightful commentary on our article “Undertriage of Elderly Trauma Patients to State-Designated Trauma Centers.”1 We would like to elaborate on some of the issues that he raised.

Dr Mullins is correct in pointing out that there are no conclusive data on outcomes of elderly patients at trauma centers. However, given the overwhelming evidence that transporting younger patients to trauma centers improves their outcomes, we argue that there is at least prima facie evidence that trauma centers may improve outcomes for elderly patients as well. We believe that there is currently insufficient justification to knowingly deny elderly trauma patients rapid access to high-quality care while continuing to provide that care to younger patients. We would also like to point out that the recently revised “Green Book”2 from the American College of Surgeons continues to recommend that patients older than 55 years be considered for triage to trauma centers because of their higher risk of death and disability.

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