title: Survival among injured geriatric patients during construction of a statewide trauma system.
abstract: BACKGROUND
  Patient outcomes are presumed to vary during early implementation of a trauma system because of fluctuations in processes of care. This study estimates risk-adjusted survival for injured geriatric patients during implementation of the Washington State trauma system.
  
  
  METHODS
  A presystem (1988-1992) versus early construction phase (1993-1995) retrospective cohort analysis of hospitalized geriatric injured patients in Washington State was conducted. Hospital data were cross-linked to death certificates, providing patient follow-up. A Cox proportional hazards model assessed survival to 60 days from hospital admission.
  
  
  RESULTS
  A total of 77,136 geriatric patients were assessed. No difference in survival was observed (before vs. after) for all geriatric injured patients. However, among severely injured patients (Injury Severity Score > 15), survival during the implementation phase increased by 5.1% compared with patients admitted during the presystem years (p = 0.03).
  
  
  CONCLUSIONS
  This study demonstrates improved survival for seriously injured geriatric trauma patients during construction of the Washington State trauma system.
authors: Intermountain Injury Control Research Center, Department of Pediatrics, University of Utah School of Medicine, 410 Chipeta Way, Salt Lake City, UT 84108-9161, USA. clay.mann@hsc.utah.edu
authors: N C
authors: NC
authors: Mann
authors: R M
authors: RM
authors: Cahn
authors: R J
authors: RJ
authors: Mullins
authors: D M
authors: DM
authors: Brand
authors: G J
authors: GJ
authors: Jurkovich
mesh_terms: D000368:Aged; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012041:Regional Medical Programs / Q000458:organization & administration*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration*; D014861:Washington / Q000453:epidemiology