Citation

Zafar SN, Obirieze A, Schneider EB, Hashmi ZG, Scott VK, Greene WR, Efron DT, MacKenzie EJ, Cornwell EE, Haider AH. J. Trauma Acute Care Surg. 2015; 78(4): 852-859.

Affiliation

From the Department of Surgery (S.N.Z., A.O., W.R.G., E.E.C.), Howard University Hospital, Washington, District of Columbia; Center for Surgical Trials and Outcomes Research (E.B.S., V.K.S., D.T.E.), School of Medicine, and Bloomberg School of Public Health (E.J.M.), John Hopkins University, Baltimore, Maryland; Department of General Surgery (Z.G.H.), Sinai Hospital Baltimore, MD; Center for Surgery and Public Health Harvard Medical School; Harvard School of Public Health; and Department of Surgery (A.H.H.), Brigham and Women's Hospital, Boston, MA.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000557

PMID

25742246

Abstract

BACKGROUND: The burden of injury among older patients continues to grow and accounts for a disproportionate number of trauma deaths. We wished to determine if older trauma patients have better outcomes at centers that manage a higher proportion of older trauma patients.

METHODS: The National Trauma Data Bank years 2007 to 2011 was used. All high-volume Level 1 and Level 2 trauma centers were included. Trauma centers were categorized by the proportion of older patients seen. Adult trauma patients were categorized as older (≥65 years) and younger adults (16-64 years). Coarsened exact matching was used to determine differences in mortality and length of stay between older and younger adults. Risk-adjusted mortality ratios by proportion of older trauma patients seen were analyzed using multivariate logistic regression models and observed-expected ratios.

RESULTS: A total of 1.9 million patients from 295 centers were included. Older patients accounted for one fourth of trauma visits. Matched analysis revealed that older trauma patients were 4.2 times (95% confidence interval, 3.99-4.50) more likely to die than younger patients. Older patients were 34% less likely to die if they presented at centers treating a high versus low proportion of older trauma (odds ratio, 0.66; 95% confidence interval, 0.54-0.81). These differences were independent of trauma center performance.

CONCLUSION: Geriatric trauma patients treated at centers that manage a higher proportion of older patients have improved outcomes. This evidence supports the potential advantage of treating older trauma patients at centers specializing in geriatric trauma. LEVEL OF EVIDENCE: Prognostic epidemiologic, level III.

Language: en