Interhospital transfers in elderly trauma patients

Abstract

INTRODUCTION: The elderly population is growing worldwide and is more likely to die from injuries that younger patients would likely survive. Furthermore, elderly trauma patients are often subjected to triage decisions that admit them to lower-level facilities. These patients may require interhospital transfer to a major trauma center for definitive care. The aim of this study was to investigate the time interval from arrival at the primary hospital to arrival at the trauma center among elderly trauma patients (≥65 years) as compared to younger, adult patients (18-64 years). We hypothesized that elderly trauma patients would endure a longer time interval.METHODS: This was a retrospective quality assurance study based on patient data in our trauma registry at the Trauma Center of Copenhagen University Hospital, Rigshospitalet in Denmark. Data were extracted in the period between 2018 to 2023. We included all adult trauma patients (≥18 years) who underwent interhospital transfer to the trauma center. The primary outcome was minutes from arrival at the primary hospital to arrival at the trauma center. A quality standard of at least 90% of patients arriving at the trauma center in less than 240 minutes after arrival at the primary hospital, was chosen.RESULTS: In total, 565 patients were included and divided into an elderly cohort (n=184) and a younger cohort (n=381). The elderly cohort had a significantly longer median delay (247 vs. 197 minutes; estimated difference 50 minutes, 95% confidence interval (CI) [28, 71]; p<0.001). The elderly cohort met the quality standard less than the younger cohort (49% vs. 68%). The elderly cohort had a significantly higher injury severity score (17 [IQR 13, 25] vs. 16 [IQR 9, 21]; p<0.001), and we found a significant difference in 30-day mortality, which was supported by an adjusted odds ratio of 6.35 (95% CI [2.84, 15.7]; p<0.001).CONCLUSIONS: In conclusion, elderly trauma patients experienced significantly longer median delays from arrival at the primary hospital to arrival at the trauma center compared to younger adult trauma patients. The elderly trauma patients met the quality standard for transfer time at a lower rate than the younger group.