Do trauma center levels matter in older isolated hip fracture patients?

Howard Nelson-Williams, Lisa Kodadek, Joseph Canner, Eric Schneider, David Thomas Efron, Elliott Haut, Babar Shafiq, Adil Haider, Catherine Garrison Velopulos

Research output: Contribution to journalArticle

Abstract

Background Younger, multi-trauma patients have improved survival when treated at a trauma center. Many regions now propose that older patients be triaged to a higher level trauma centers (HLTCs - level I or II) versus lower level trauma centers (LLTCs - level III or nondesignated TC), even for isolated injury, despite the absence of an established benefit in this elderly cohort. We therefore sought to determine if older isolated hip fracture patients have improved survival outcomes based on trauma center level. Methods A retrospective cohort of 1.07 million patients in The Nationwide Emergency Department Sample from 2006-2010 was used to identify 239,288 isolated hip fracture patients aged ≥ 65 y. Multivariable logistic regression was performed controlling for patient- and hospital-level variables. The main outcome measures were inhospital mortality and discharge disposition. Results Unadjusted logistic regression analyses revealed 8% higher odds of mortality (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.00-1.16) and 10% lower odds of being discharged home (OR, 0.90; 95% CI, 0.80-1.00) among patients admitted to an HLTC versus LLTC. After controlling for patient- and hospital-level factors, neither the odds of mortality (OR, 1.06; 95% CI, 0.97-1.15) nor the odds of discharge to home (OR, 0.98; 95% CI, 0.85-1.12) differed significantly between patients treated at an HLTC versus LLTC. Conclusions Among patients with isolated hip fractures admitted to HLTCs, mortality and discharge disposition do not differ from similar patients admitted to LLTCs. These findings have important implications for trauma systems and triage protocols.

Original languageEnglish (US)
Pages (from-to)468-474
Number of pages7
JournalJournal of Surgical Research
Volume198
Issue number2
DOIs
StatePublished - Oct 1 2015

Fingerprint

Trauma Centers
Hip Fractures
Odds Ratio
Confidence Intervals
Mortality
Wounds and Injuries
Logistic Models
Survival
Triage
Hospital Mortality
Hospital Emergency Service
Regression Analysis
Outcome Assessment (Health Care)

Keywords

  • Discharge disposition
  • Geriatric trauma
  • Isolated hip fracture
  • Mortality
  • Trauma center
  • Triage

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Nelson-Williams, H., Kodadek, L., Canner, J., Schneider, E., Efron, D. T., Haut, E., ... Velopulos, C. G. (2015). Do trauma center levels matter in older isolated hip fracture patients? Journal of Surgical Research, 198(2), 468-474. https://doi.org/10.1016/j.jss.2015.03.074

Do trauma center levels matter in older isolated hip fracture patients? / Nelson-Williams, Howard; Kodadek, Lisa; Canner, Joseph; Schneider, Eric; Efron, David Thomas; Haut, Elliott; Shafiq, Babar; Haider, Adil; Velopulos, Catherine Garrison.

In: Journal of Surgical Research, Vol. 198, No. 2, 01.10.2015, p. 468-474.

Research output: Contribution to journalArticle

Nelson-Williams, H, Kodadek, L, Canner, J, Schneider, E, Efron, DT, Haut, E, Shafiq, B, Haider, A & Velopulos, CG 2015, 'Do trauma center levels matter in older isolated hip fracture patients?', Journal of Surgical Research, vol. 198, no. 2, pp. 468-474. https://doi.org/10.1016/j.jss.2015.03.074
Nelson-Williams, Howard ; Kodadek, Lisa ; Canner, Joseph ; Schneider, Eric ; Efron, David Thomas ; Haut, Elliott ; Shafiq, Babar ; Haider, Adil ; Velopulos, Catherine Garrison. / Do trauma center levels matter in older isolated hip fracture patients?. In: Journal of Surgical Research. 2015 ; Vol. 198, No. 2. pp. 468-474.
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abstract = "Background Younger, multi-trauma patients have improved survival when treated at a trauma center. Many regions now propose that older patients be triaged to a higher level trauma centers (HLTCs - level I or II) versus lower level trauma centers (LLTCs - level III or nondesignated TC), even for isolated injury, despite the absence of an established benefit in this elderly cohort. We therefore sought to determine if older isolated hip fracture patients have improved survival outcomes based on trauma center level. Methods A retrospective cohort of 1.07 million patients in The Nationwide Emergency Department Sample from 2006-2010 was used to identify 239,288 isolated hip fracture patients aged {\^a}‰¥ 65 y. Multivariable logistic regression was performed controlling for patient- and hospital-level variables. The main outcome measures were inhospital mortality and discharge disposition. Results Unadjusted logistic regression analyses revealed 8{\%} higher odds of mortality (odds ratio [OR], 1.08; 95{\%} confidence interval [CI], 1.00-1.16) and 10{\%} lower odds of being discharged home (OR, 0.90; 95{\%} CI, 0.80-1.00) among patients admitted to an HLTC versus LLTC. After controlling for patient- and hospital-level factors, neither the odds of mortality (OR, 1.06; 95{\%} CI, 0.97-1.15) nor the odds of discharge to home (OR, 0.98; 95{\%} CI, 0.85-1.12) differed significantly between patients treated at an HLTC versus LLTC. Conclusions Among patients with isolated hip fractures admitted to HLTCs, mortality and discharge disposition do not differ from similar patients admitted to LLTCs. These findings have important implications for trauma systems and triage protocols.",
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AU - Kodadek, Lisa

AU - Canner, Joseph

AU - Schneider, Eric

AU - Efron, David Thomas

AU - Haut, Elliott

AU - Shafiq, Babar

AU - Haider, Adil

AU - Velopulos, Catherine Garrison

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N2 - Background Younger, multi-trauma patients have improved survival when treated at a trauma center. Many regions now propose that older patients be triaged to a higher level trauma centers (HLTCs - level I or II) versus lower level trauma centers (LLTCs - level III or nondesignated TC), even for isolated injury, despite the absence of an established benefit in this elderly cohort. We therefore sought to determine if older isolated hip fracture patients have improved survival outcomes based on trauma center level. Methods A retrospective cohort of 1.07 million patients in The Nationwide Emergency Department Sample from 2006-2010 was used to identify 239,288 isolated hip fracture patients aged ≥ 65 y. Multivariable logistic regression was performed controlling for patient- and hospital-level variables. The main outcome measures were inhospital mortality and discharge disposition. Results Unadjusted logistic regression analyses revealed 8% higher odds of mortality (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.00-1.16) and 10% lower odds of being discharged home (OR, 0.90; 95% CI, 0.80-1.00) among patients admitted to an HLTC versus LLTC. After controlling for patient- and hospital-level factors, neither the odds of mortality (OR, 1.06; 95% CI, 0.97-1.15) nor the odds of discharge to home (OR, 0.98; 95% CI, 0.85-1.12) differed significantly between patients treated at an HLTC versus LLTC. Conclusions Among patients with isolated hip fractures admitted to HLTCs, mortality and discharge disposition do not differ from similar patients admitted to LLTCs. These findings have important implications for trauma systems and triage protocols.

AB - Background Younger, multi-trauma patients have improved survival when treated at a trauma center. Many regions now propose that older patients be triaged to a higher level trauma centers (HLTCs - level I or II) versus lower level trauma centers (LLTCs - level III or nondesignated TC), even for isolated injury, despite the absence of an established benefit in this elderly cohort. We therefore sought to determine if older isolated hip fracture patients have improved survival outcomes based on trauma center level. Methods A retrospective cohort of 1.07 million patients in The Nationwide Emergency Department Sample from 2006-2010 was used to identify 239,288 isolated hip fracture patients aged ≥ 65 y. Multivariable logistic regression was performed controlling for patient- and hospital-level variables. The main outcome measures were inhospital mortality and discharge disposition. Results Unadjusted logistic regression analyses revealed 8% higher odds of mortality (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.00-1.16) and 10% lower odds of being discharged home (OR, 0.90; 95% CI, 0.80-1.00) among patients admitted to an HLTC versus LLTC. After controlling for patient- and hospital-level factors, neither the odds of mortality (OR, 1.06; 95% CI, 0.97-1.15) nor the odds of discharge to home (OR, 0.98; 95% CI, 0.85-1.12) differed significantly between patients treated at an HLTC versus LLTC. Conclusions Among patients with isolated hip fractures admitted to HLTCs, mortality and discharge disposition do not differ from similar patients admitted to LLTCs. These findings have important implications for trauma systems and triage protocols.

KW - Discharge disposition

KW - Geriatric trauma

KW - Isolated hip fracture

KW - Mortality

KW - Trauma center

KW - Triage

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