Outcomes of trauma care at centers treating a higher proportion of older patients: The case for geriatric trauma centers

Syed Nabeel Zafar, Augustine Obirieze, Eric B. Schneider, Zain G. Hashmi, Valerie K. Scott, Wendy R. Greene, David Thomas Efron, Ellen J Mackenzie, Edward E. Cornwell, Adil H. Haider

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The burden of injury among older patients continues to growand 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.

Original languageEnglish (US)
Pages (from-to)852-859
Number of pages8
JournalThe journal of trauma and acute care surgery
Volume78
Issue number4
DOIs
StatePublished - Apr 4 2015

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Trauma Centers
Geriatrics
Wounds and Injuries
Young Adult
Logistic Models
Confidence Intervals
Mortality
Length of Stay

Keywords

  • Geriatric trauma
  • health care costs
  • outcomes
  • trauma systems

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Medicine(all)

Cite this

Outcomes of trauma care at centers treating a higher proportion of older patients : The case for geriatric trauma centers. / Zafar, Syed Nabeel; Obirieze, Augustine; Schneider, Eric B.; Hashmi, Zain G.; Scott, Valerie K.; Greene, Wendy R.; Efron, David Thomas; Mackenzie, Ellen J; Cornwell, Edward E.; Haider, Adil H.

In: The journal of trauma and acute care surgery, Vol. 78, No. 4, 04.04.2015, p. 852-859.

Research output: Contribution to journalArticle

Zafar, Syed Nabeel ; Obirieze, Augustine ; Schneider, Eric B. ; Hashmi, Zain G. ; Scott, Valerie K. ; Greene, Wendy R. ; Efron, David Thomas ; Mackenzie, Ellen J ; Cornwell, Edward E. ; Haider, Adil H. / Outcomes of trauma care at centers treating a higher proportion of older patients : The case for geriatric trauma centers. In: The journal of trauma and acute care surgery. 2015 ; Vol. 78, No. 4. pp. 852-859.
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