Abstract
Trauma centers improve outcomes for young patients with serious injuries. However, most injury-related hospital admissions and deaths occur in older adults, and it is not clear whether trauma center care provides the same benefit in this population. To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital's trauma center level. This prospective, population-based cohort study used Medicare claims data from January 1, 2013, to December 31, 2016, for all fee-for-service Medicare beneficiaries 66 years or older with inpatient admission for traumatic injury in 2014 to 2015. Data analysis was performed from January 1 to June 31, 2021. Preinjury health was measured using 2013 claims, and outcomes were measured through 2016. The population was stratified by anatomical injury pattern. Propensity scores for level I trauma center treatment were estimated using the Abbreviated Injury Scale, age, and residential proximity to trauma center and then used to match beneficiaries from each trauma level (I, II, III, and IV/non-trauma centers) by injury type. Admitting hospital's trauma center level. Case fatality rates (CFRs) at 30 and 365 days after injury, estimated in the matched sample using multivariable, hierarchical logistic regression models. A total of 433 169 Medicare beneficiaries (mean [SD] age, 82.9 [8.3] years; 68.4% female; 91.5% White) were included in the analysis. A total of 206 275 (47.6%) were admitted to non-trauma centers and 161 492 (37.3%) to level I or II trauma centers. Patients with isolated extremity fracture had the fewest deaths (365-day CFR ranged from 16.1% [95% CI, 11.2%-22.4%] to 17.4% [95% CI, 11.8%-24.6%] by trauma center status). Patients with both hip fracture and traumatic brain injury had the most deaths (365-day CFRs ranged from 33.4% [95% CI, 25.8%-42.1%] to 35.8% [95% CI, 28.9%-43.5%]). These findings suggest that older adults do not benefit from existing trauma center care, which is designed with younger patients in mind. There is a critical need to improve trauma care practices to address common injury mechanisms and types of injury in older adults.
Highlights
3 000 000 US older adults experience traumatic injury each year, resulting in 50 000 deaths and $19 billion in lifetime health care costs for survivors.[1]
These findings suggest that older adults do not benefit from existing trauma center care, which is designed with younger patients in mind
Key Points Question Is long-term mortality of injured older adults associated with the treating hospital’s trauma center level?. In this population-based cohort study of long-term mortality among 433 169 older Medicare beneficiaries with injuries, mortality rates did not vary by trauma center status. Meaning These findings suggest that older adults do not benefit from existing trauma center care in the same ways as younger adults, indicating a need for revised trauma care guidelines and clinical practices that meet the needs of injured older adults
Summary
3 000 000 US older adults experience traumatic injury each year, resulting in 50 000 deaths and $19 billion in lifetime health care costs for survivors.[1]. National guidelines recommend trauma center (TC) care for injured older adults when possible,[2] based on evidence that younger, critically injured patients benefit from TC care, risk of death after injury increases with age, and emergency medical services (EMS) personnel may underestimate injury severity in older adults.[2]. The National Study on the Costs and Outcomes of Trauma, the most rigorous study of TC effectiveness to date, demonstrated a 40% reduction in 1-year mortality for trauma patients younger than 55 treated at TCs and no difference in mortality between older adults treated at TCs and non-trauma centers (NTCs).[5]. A study[8] using trauma registry data on critically injured patients from Utah and Northern California suggested higher mortality for older adults treated at TCs. In 2017, the National Academies of Sciences, Engineering, and Medicine noted sparse evidence informing best practices for geriatric trauma care as a significant weakness of the US trauma care system.[9]
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