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Richard J. Mullins, MD

Arch Surg. 2008;143(8):782.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Statewide trauma systems require 3 components: trauma centers (TCs), committed trauma care providers, and rational, effective triage mechanisms. Chang and coinvestigators observed that only 50% of elderly patients who met triage criteria were transported to 1 of Maryland's 8 TCs. One cause for this was a potential age bias among EMS providers. The authors dismissed 3 pertinent issues:

1. There is no evidence that elderly injured patients would benefit from transport to TCs. In the authoritative National Study on the Costs and Outcomes of Trauma, patients older than 55 years treated in TCs did not have superior odds of survival.¹ That elderly patients would benefit from transport to TCs is a hypothesis.
   
2. Maryland's trauma system designates only 20% of acute care hospitals as TCs. Trauma systems improved survival in states in which more than 50% of hospitals are categorized as TCs.² Elderly patients are undertriaged in Maryland . . . [Full Text of this Article]

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