Improvement in geriatric trauma outcomes in an evolving trauma system

Abstract

BackgroundThe elderly trauma patient has increased mortality compared with younger patients. During the last 15 years, initial treatment of severely injured patients at Oslo University Hospital Ulleval (OUHU) has changed resulting in overall improved outcomes. Whether this holds true for the elderly trauma population needs exploration and was the aim of the present study.MethodsWe performed a retrospective study of 2628 trauma patients 61 years or older admitted to OUHU during the 12-year period, 2002–2013. The population was stratified based on age (61–70 years, 71–80 years, 81 years and older) and divided into time periods: 2002–2009 (P1) and 2010–2013 (P2). Multiple logistic regression models were constructed to identify clinically relevant core variables correlated with mortality and trauma team activation rate.ResultsCrude mortality decreased from 19% in P1 to 13% in P2 (p<0.01) with an OR of 0.77 (95 %CI 0.65 to 0.91) when admitted in P2. Trauma team activation rates increased from 53% in P1 to 72% in P2 (p<0.01) with an OR of 2.16 (95% CI 1.93 to 2.41) for being met by a trauma team in P2. Mortality increased from 10% in the age group 61–70 years to 26% in the group above 80 years. Trauma team activation rates decreased from 71% in the age group 61–70 years to 50% in the age group older than 80 years. Median ISS were 17 in all three age groups and in both time periods.DiscussionDevelopment of a multidisciplinary dedicated trauma service is associated with increased trauma team activation rate as well as survival in geriatric trauma patients. As expected, mortality increased with age, although inversely related to the likelihood of being met by a trauma team. Trauma team activation should be considered for all trauma patients older than 70 years.Level of evidenceLevel IV.

Epidemiology of geriatric trauma patients in Norway: A nationwide analysis of Norwegian Trauma Registry data, 2015–2018. A retrospective cohort study

“…However, improvements in outcome is achievable, as demonstrated by a Norwegian study by Ringen et al which assessed the mortality for geriatric patients in an evolving trauma system over 12 years. They found a general survival benefit, with an OR of 0.77 if admitted in the second half of the time period, possibly due to multifactorial improvements over time [23] .…”

Is higher-level trauma center care associated with better outcomes in patients injured by low-energy trauma?

“…This hypothesis is supported by several studies which demonstrate improved outcomes when extra resources are dedicated to prompt, comprehensive assessment and holistic management of low-energy trauma patients. 16,17,38,39 Implications for Future Research This result demonstrates that the role of higher-level trauma centers in the care of patients suffering low-energy trauma requires further research. Studies at lower risk of bias and studies in non-US trauma systems and populations are required.…”

Evaluation of elderly specific pre-hospital trauma triage criteria: a systematic review

“…Trauma units may be the most appropriate location of care and offer multiple advantages over major trauma centres for elderly patients [ 45 ], hence measuring triage in terms of transportation location may be overly simplistic. Pre-hospital identification of those at high risk of adverse outcome may direct in-hospital care such as differential levels of trauma activation, earlier imaging and senior clinician assessment, use of multi-disciplinary elderly trauma teams, inform hospital care pathways, and support staff guidance and education [ 46 , 47 ]. This has the potential to use finite resources in a more precise and targeted manner.…”