Trauma center versus non–trauma center admissions in adult trauma victims by age and gender

Abstract

ObjectiveThe admission types and appropriateness of admission of adults with differing levels of injury severity were compared, based on patient age and gender. MethodsThis retrospective study used a statewide hospital discharge dataset. The patients included adults who had sustained trauma related to motor vehicles and were admitted to trauma center (TCs) and non–trauma center (NTCs) hospitals. Using injury severity scores (ISSs) ≥ 16 to denote major trauma, the proportion of patients with major traumatic injuries who were admitted to TCs and NTCs was determined. Types of admission (TC versus NTC) were compared by age and gender for four subgroups of men and women, aged 25 to 64 years, and aged 65 years and older. ResultsThe sample included 5,712 patients. Of those patients with ISS ≥ 16, younger men were most likely to be admitted to a TC (82%), and older women were least likely to be admitted to a TC (60%). The proportions of older men and women with ISS ≥ 16 who were admitted to a TC were comparable. Among patients with ISS < 16 admitted to NTCs, older women were the highest proportion (65%), and younger men were the lowest proportion (43%). Overall, more older men and women with ISS ≥ 16 were admitted to NTCs than would have been expected. Conversely, a statistically significant proportion of younger men and women with ISS<16 were admitted to TCs. ConclusionFindings suggest that older trauma victims whose injuries appear to be serious are admitted to NTCs more often than are younger trauma victims with similarly serious injuries. Additional studies to examine this phenomenon are warranted.