Outcomes of care at higher-level trauma centers in octogenarians with a history of anticoagulant use who fall from ground level

Abstract

BackgroundThe appropriate care of octogenarian trauma patients after a fall from ground level (FFGL) is a key factor for better outcomes. The purpose of this study is to use data from a national database to evaluate the outcomes of patients who are 80–89 years old with a history of anticoagulant use, sustained a FFGL, and were treated at a higher-level care institution. MethodsThe Trauma Quality Improvement Program (TQIP) database of the calendar year 2017–2018 was accessed for the study. All hospitalized trauma patients between the ages of 80–89 years old with a history of anticoagulant use and sustaining an injury after FFGL were included in the study. Other variables included in the study are sex [male], race [white], initial systolic blood pressure (SBP mmHg), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hypotension with an SBP<110 mmHg and other comorbidities. The outcomes of the patients were compared with the care at higher-level trauma centers (Level I & Level II) and lower-level trauma centers (Level III) using propensity matched analysis. ResultsAfter propensity matching, 2348 patients were identified in each group. There was no clinically significant difference between the patients’ characteristics who were treated at higher-level and lower-level care centers. A paired matched analysis showed greater mortality in patients who were treated at higher-level care centers compared to lower-level care centers (3.7% vs 2.6%, P = 0.03). The absolute difference in mortality was 1.1%[95% CI: 0.001, 0.022] which may not have any clinical relevance. A greater number of patients were discharged to home and a lesser number of patients were discharged to a skilled nursing facility (SNF) when they were treated at higher-level trauma centers. Conclusion & relevanceThe care at higher-level trauma centers did not show any benefit in-hospital mortality in the short term. A higher number of patients was discharged to home without assistance.