Geriatric Trauma Patients—Are They Receiving Trauma Center Care?

Lane, Peter L.; Sorondo, Barbara M.; Kelly, John

doi:10.1197/aemj.10.3.244

Cited by 65 publications

(29 citation statements)

References 20 publications

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“…This could be associated with the less aggressive care provided to older adults seen in the present study or the influence of do-not-resuscitate orders. The present study is in agreement with previous reports that demonstrated that older adults are less likely to be provided care at a level 1 trauma center (32,33).…”

Section: Discussionsupporting

confidence: 83%

Evaluation of the effect of intensity of care on mortality after traumatic brain injury

Thompson

Rivara

Jurkovich

et al. 2008

Critical Care Medicine

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Objectives-To evaluate the effect of age on intensity of care provided to traumatically braininjured adults and to determine the influence of intensity of care on mortality at discharge and 12 months postinjury, controlling for injury severity.Design-Cohort study using the National Study on the Costs and Outcomes of Trauma (NSCOT) database. Risk ratio and Poisson regression analyses were performed using data weighted according to the population of eligible patients.Setting and Patients-A total of 18 level 1 and 51 level 2 non-trauma centers located in 14 states in the United States and 1,776 adults aged 25−84 yrs with a diagnosis of traumatic brain injury. Measurements-Injury severity was determined by the motor component of the Glasgow ComaScale score, the Injury Severity Score, pupillary reactivity, and presence of midline shift. Factors evaluated as contributing to intensity of care included: admission to the intensive care unit, mechanical ventilation, placement of an intracranial pressure monitor, placement of a jugular bulb catheter, placement of a pulmonary artery catheter, critical care consultation, the number of specialty care consultations, mannitol use, treatment with barbiturate coma, decompressive craniectomy, number of nonneurosurgical procedures performed, the presence of a do-not-resuscitate order, and withdrawal of therapy.Main Results-Controlling for injury-related factors, sex, and comorbidity, as age increased, the overall likelihood of receiving various interventions decreased. After controlling for injury severity, sex, and comorbidity, factors associated with higher risk of in-hospital death were: being aged 75 −84 yrs (relative risk [RR] 1.32, 95% confidence interval [CI] 1.13, 1.55), pulmonary artery catheter use (RR 1.56, 95% CI 1.30, 1.86), intubation (RR 4.17, 95% CI 2.28, 7.61), the presence of a donot-resuscitate order (RR 3.21, 95% CI 2.21, 4.65), and withdrawal of therapy (RR 2.33, 95% CI 1.69, 3.23). In contrast, a higher number of specialty care consultations (surgical consults: RR 0.63, 95% CI 0.54, 0.74; medical consults: RR 0.87, 95% CI 0.79, 0.95; and other consults: RR 0.43, 95% CI 0.26, 0.69) were associated with decreased risk of death. The results were similar for factors associated with death at 12 months, with the exception that the number of medical consultations was not significant, whereas the number of nonneurosurgical procedures performed was associated with lower risk of death (RR 0.96, 95% CI 0.92, 0.99), as was obtaining critical care consultation services (RR 0.84, 95% CI 0.71, 1.0).Conclusions-There is a lower intensity of care provided to older adults with traumatic brain injury. Although the specific contributions of specialists to patient management are unknown, theirThe authors have not disclosed any potential conflicts of interest.Work for this study was performed at the University of Washington, Seattle, WA. By the year 2030, the number of Americans aged ≥65 will exceed 70 million, doubling current figures (1). Along with this increase in the...

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Section: Discussionsupporting

confidence: 83%

Evaluation of the effect of intensity of care on mortality after traumatic brain injury

Thompson

Rivara

Jurkovich

et al. 2008

Critical Care Medicine

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“…39,44 Consistent with prior studies, [47][48][49][50] results presented here indicate that injury severity, older age, and hypotension at admission are strong predictors of in-hospital death among older adults with TBI. It should be noted that the ORs by age increase when injury severity is added to the model predicting death, which suggests that, even after milder injuries, older people may still be at increased risk for death, compared to younger people.…”

Section: Dams-o'connor Et Alsupporting

confidence: 89%

“…39,40 Several studies have suggested that adults over the age of 65 years have higher undertriage rates 41,42 and are less likely to have trauma team involvement 43 than their younger counterparts, suggesting that they are less likely to be transported to a hospital that is equipped to provide trauma care, such as a level I or II trauma center. 39,44 An important and indirect finding in this study is that a much smaller proportion of older adults are treated in a level I or II trauma center for TBI than would be expected based on hospital admissions for older adults with TBI. To evaluate this, we calculated the cumulative number of cases with TBI noted in the nationally weighted NTDB data sets (2007 thru 2010) who were 75 years of age and older that met our inclusion characteristics and divided this value by the cumulative number of adults 75 and older living in the United States between 2007 and 2010 according to U.S. Census data.…”

Section: Dams-o'connor Et Almentioning

confidence: 99%

“…The NTDB includes data from hospitals that are designated by the American College of Surgeons as trauma centers, and we excluded from these analyses any cases that were transferred in, so findings presented here may not reflect the care provided to older adults with TBI who are treated in other facilities, such as urgent care centers and community hospitals. There is some evidence that older adults are less likely to be treated at a designated trauma center than younger adults, 39,44 so the generalizability of these findings to all older adults with a diagnosis of TBI is not clear. Several variables that may be essential in predicting TBI outcomes among older adults were unavailable (e.g., pre-existing medical conditions) or were not commonly recorded across NTDB hospitals (e.g., in-hospital procedures and complications).…”

Section: Limitationsmentioning

confidence: 99%

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Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers

Dams-O’Connor

Cuthbert

Whyte

et al. 2013

Journal of Neurotrauma

107

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Individuals 65 years of age and over have the highest rates of traumatic brain injury (TBI)-related hospitalizations and deaths, and older adults (defined variably across studies) have particularly poor outcomes after TBI. The factors predicting these outcomes remain poorly understood, and age-specific care guidelines for TBI do not exist. This study provides an overview of TBI in older adults using data from the National Trauma Data Bank (NTDB) gathered between 2007 and 2010, evaluates age group-specific trends in rates of TBI over time using U.S. Census data, and examines whether routinely collected information is able to predict hospital discharge status among older adults with TBI in the NTDB. Results showed a 20-25% increase in trauma center admissions for TBI among the oldest age groups (those > = 75 years), relative to the general population, between 2007 and 2010. Older adults ( > = 65 years) with TBI tended to be white females who have incurred an injury from a fall resulting in a ''severe'' Abbreviated Injury Scale (AIS) score of the head. Older adults had more in-hospital procedures, such as neuroimaging and neurosurgery, tended to experience longer hospital stays, and were more likely to require continued medical care than younger adults. Older age, injury severity, and hypotension increased the odds of in-hospital death. The public health burden of TBI among older adults will likely increase as the Baby Boom generation ages. Improved primary and secondary prevention of TBI in this cohort is needed.

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“…The prehospital advanced life support has been reported to be an important component of trauma care in general and particularly in elderly trauma patients, and plays a vital role in determining the final outcome of treatment when done appropriately (Lane et al, 2003;Jacobs et al, 2003;Scheetz, 2003). In the present study, prehospital treatment was reported in only 5.3% of geriatric injury patients seen at the A&E department as a result the majority of them were brought in by relatives, Good Samaritan and police who are not trained on how to take care these patients during transportation.…”

Section: Discussionmentioning

confidence: 99%

Geriatric injuries among patients attending a regional hospital in Shinyanga Tanzania

Chalya

Mabula

Ngayomela

et al. 2012

Tanzania J Hlth Res

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Geriatric injuries pose a major challenge to surgeons and general practitioners in developing countries. The objective of this study was to determine the prevalence, injury characteristics and outcomes of geriatric injury among patients at Shinyanga Regional Hospital in Tanzania. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7% of all trauma admissions were studied. The male to female ratio was 1.4:1. Their mean age was 68.5 years (ranged 60-98 years). Premorbid illness was reported in 38.3% of patients. Most injuries were intentional in fifty-three (56.4%) patients. Assaults, falls and road traffic crashes were the mechanism of injuries in 52.1%, 19.1% and 11.7% of cases, respectively. The majority of cases of assault were females accounting for 64.6%. The majority of injuries (81.9%) occurred at home. Pre-hospital care was recorded in 5.3% of cases. The musculoskeletal (72.3%) and head (66.0%) regions were commonly affected. Soft tissue injuries (wounds) (89.4%) and fractures (52.2%) were the most common type of injuries. The majority of patients (90.4%) underwent surgical treatment of which wound debridement was the most common procedure performed in 91.8% of cases. Complication rate was 39.4%. The mean length of hospital stay was 28.6 days (ranged 1 -124 days). The length of hospital stay was significantly longer in patients with co-morbidities, long bone fractures and those with complications (P<0.05). Mortality rate was 14.9% and it was significantly related to advanced age, presence of pre-morbid illness, high injury severity score, severe head injuries and the need for ventilatory support (P< 0.05). In conclusion, traumatic injuries in elderly constitute a major but preventable public health problem in Shinyanga region and contribute significantly to high morbidity and mortality. Urgent preventive measures focusing at the root causes of the injuries and early appropriate treatment is highly needed to reduce the occurrence, morbidity and mortality associated with these injuries. ____________________________________________________________________________________________

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Geriatric Trauma Patients—Are They Receiving Trauma Center Care?

Cited by 65 publications

References 20 publications

Evaluation of the effect of intensity of care on mortality after traumatic brain injury

Evaluation of the effect of intensity of care on mortality after traumatic brain injury

Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers

Geriatric injuries among patients attending a regional hospital in Shinyanga Tanzania

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