A population-based study of geriatric trauma in a rural state.
BACKGROUND
Urban geriatric trauma patients are known to die more often than their younger counterparts. Little is known of the fate of geriatric trauma patients in a rural environment where delays to definitive treatment are frequent. We hypothesized that rural trauma patients would do worse than their urban counterparts because of prolonged delays to definitive care.


METHODS
Five-year retrospective analysis of all trauma deaths occurring within a rural state and retrospective outcome analysis of trauma patients admitted to a tertiary care facility who were less than 55 years old (defined as young) and 55 or more years old (defined as old). Outcome analysis was performed comparing old and young rural hospitalized patients to the Major Trauma Outcome Study data set collected in major urban trauma centers.


RESULTS
Of the total trauma deaths in the state, 32.5% were old. Old patients were less likely to die at the scene of the injury than were their younger counterparts (R2 = 0.84, p < 0.001). Hospitalized old patients had a significantly higher mean Revised Trauma Score and a significantly lower Injury Severity Score, a higher complication rate, and a higher mortality rate than did hospitalized young patients. The young group had a significantly better survival (W = 0.59, Z = -3.49, p = 0.0001) than the MTOS data set, but the old group had a significantly worse survival (W = -1.8, Z = -3.49, p = 0.001).


CONCLUSIONS
In a rural environment, old trauma patients die more commonly in the hospital than their younger counterparts, who die more commonly at the scene. Old trauma patients who die in the hospital were less severely injured than their younger counterparts who died in the hospital. Old patients admitted to this rural trauma center have a significantly worse survival than their urban counterparts despite the fact that young rural trauma patients do significantly better than their urban counterparts. Understanding the demographics of rural geriatric trauma may be useful in allocating resources in rural trauma system design. It must be understood that despite relatively low injury severity and physiologic stability, there is a significant potential for rural geriatric trauma patients to do poorly.
Rogers
F B
FB
Department of Surgery, University of Vermont, Burlington, Vermont 05401, USA. fredericks.rogers@vtmednet.org
Osler
T M
TM
Shackford
S R
SR
Morrow
P L
PL
Sartorelli
K H
KH
Camp
L
L
Healey
M A
MA
Martin
F
F
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005066:Euthanasia, Passive / Q000706:statistics & numerical data; D015276:Health Care Rationing; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009104:Multiple Trauma / Q000145:classification / Q000209:etiology / Q000401:mortality*; D020380:Needs Assessment; D011159:Population Surveillance; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D012423:Rural Health / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014707:Vermont / Q000453:epidemiology