Geriatric Trauma Mortality: Does Trauma Center Level Matter?

Abstract

Background Given their mostly rural/suburban locations, level II trauma centers (TCs) may offer greater exposure to and experience in managing geriatric trauma patients. We hypothesized that geriatric patients would have improved outcomes at level II TCs compared to level I TCs. Methods The Pennsylvania Trauma Outcome Study (PTOS) database was retrospectively queried from 2003 to 2017 for geriatric (age ≥65 years) trauma patients admitted to level I and II TCs in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in care between level I and II TCs. A multivariate logistic regression model assessed the adjusted impact of care at level I vs II TCs on mortality, complications, and functional status at discharge (FSD). The National Trauma Data Bank (NTDB) was retrospectively queried for geriatric (age ≥65 years) trauma admissions to state-accredited level I or level II TCs in 2013. Results 112 648 patients met inclusion criteria. The proportion of geriatric trauma patients across level I and level II TCs were determined to be 29.1% and 36.2% ( P <.001), respectively. In adjusted analysis, there was no difference in mortality (adjusted odds ratio [AOR]: 1.13; P = .375), complications (AOR: 1.25; P = .080) or FSD (AOR: 1.09; P = .493) when comparing level I to level II TCs. Adjusted analysis from the NTDB (n = 144 622) also found that mortality was not associated with TC level (AOR: 1.04; P = .182). Discussion Level I and level II TCs had similar rates of mortality, complications, and functional outcomes despite a higher proportion (but lower absolute number) of geriatric patients being admitted to level II TCs. Future consideration for location of centers of excellence in geriatric trauma should include both level I and II TCs.

Evaluating associations between level of trauma care and outcomes of patients with specific severe injuries: A systematic review and meta-analysis

“…[67][68][69] Comparing top levels of trauma care indicates no differences between centers. [68][69][70][71] In the present study, a level of care association with outcomes has been studied from a subgroup perspective mostly based on injured body region. When looking at case mix differences between levels of trauma, what is considered as severely injured is under debate.…”

“…Studies on severely injured (very) elderly indicate beneficial care in higher level trauma centers, despite many geriatric trauma patients being admitted to lower level trauma centers as a stable older trauma patient with lower energy injury mechanisms 67–69 . Comparing top levels of trauma care indicates no differences between centers 68–71 …”

Application of the Geriatric Trauma Outcome Score in a Rural Setting

“…9–13 Since geriatric trauma mortality is not necessarily dependent on the level of trauma center where the patient is receiving care, the GTO score could potentially be used to aid in determining the benefits and risks of potential nontherapeutic transfers among the geriatric patient population. 14…”

Use of neural network based on international classification ICD-10 in patients with head and neck injuries in Lublin Province, Poland, between 2006–2018, as a predictive value of the outcomes of injury sustained

“…The population structure of European residents suffering from TBI have been presented by Majdan at al. [10], according to which men are more likely to suffer from this injury (61%) than women (39%); however, in the population over 65 years of age this proportion is reversed [12,13]. Currently, head injuries affect mainly elderly patients, although they are also relatively common among young adults [5,6].…”