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Abstract

Introduction: Studies from the National Trauma Data Bank document that aggregate assessment of trauma center performance does not adequately reflect the care of injured elderly patients. Concordance for center performance across age strata evidenced poor agreement. Elderly trauma patients warrant special attention in performance improvement (PI) programs. Hypothesis: A PI program focused on critical care of severely injured elderly patients is associated with improved outcomes. Methods: Prospective cohort study over 8 years (2004-2011) in a single Level I Trauma Center. Outcomes of all elderly trauma patients (>65 years) were compared to institutional baselines (years 2004-2006) and national benchmarks (NTDB, TQIP). Data were collected prospectively by a single Trauma Registrar. Results: TQIP national data confirms that overall mortality is significantly higher in elderly trauma patients (9.6%, n=25,690 vs. 7.1%, n=85,569), particularly in blunt multisystem injury (elderly 20.1% mortality, n=3,525 vs. 13.9%, n=17,270). NTDB national data confirms high mean mortality rate of 36.3% for severely injured elderly patients (ISS>24) vs. 8.3% for ISS=16-24, 3.5% for ISS=9-15, and 1.9% for ISS<9. Our institutional total elderly mortality for 2010 was 6.8%, with mean time to death of 4.3 days. Our TQIP risk-adjusted outcomes were Observed/Expected Ratio=0.75 for All Elderly and O/E=0.74 for Blunt Multisystem Elderly trauma patients, reflective of high-performing centers. Furthermore, mortality rates in elderly patients with ISS>24 significantly decreased (p<0.001) from a mean mortality rate of 30.5% (2004-2006) to 16.2% (2007-2011). Institutional data for our total trauma cohort was O/E=0.60 for all trauma patients and O/E=0.78 for Blunt Multisystem trauma patients, similar to outcomes in our elderly cohort. Conclusions: Elderly trauma PI programs which stress collaboration amongst trauma surgeons, intensivists, and geriatric specialists, provide optimal critical resources to ensure improved outcomes in injured elderly patients. Trauma centers can be high-performing centers for both young and elderly trauma victims if trauma PI is focused on the provision of multidisciplinary critical care in the severely injured.