Initial presentation of older injured patients to high-volume hospitals is not associated with lower 30-day mortality in Medicare data.
OBJECTIVE
To evaluate whether survival of older patients with severe injuries is positively associated with initial presentation to high-volume trauma hospitals.


METHODS
Historical cohort study.


METHODS
We analyzed Medicare fee-for-service records. Cases were classified by maximum Abbreviated Injury Score (AISmax); those with isolated hip fractures or AISmax <3 were excluded. The initial hospital (emergency department or inpatient) for each case was classified by its number of included inpatient cases.


METHODS
Patients aged >or=65 with principal injury diagnoses (ICD-9 800-959, excluding 905, 930-939, 958) admitted to hospitals or who died in emergency departments during 1999.


METHODS
None.


RESULTS
Thirty-day mortality was determined using Medicare denominator data and modeled as a function of hospital volume, AISmax, age, gender, and comorbidity. We found that 95,867 patients (74,894 AISmax = 3; 17,932 AISmax = 4; 3,041 AISmax = 5) were managed in 4,391 hospitals. More than 90% of the interhospital transfers were from emergency departments, mostly from low-volume to high-volume hospitals, and were more frequent with greater severity. Regression models showed no difference in 30-day survival between patients taken first to low-volume hospitals (and possibly transferred) vs. patients taken directly to high-volume hospitals. Prior studies showing a positive or negative effect of hospital volume on survival of older patients could be replicated but their findings could not be generalized.


CONCLUSIONS
Existing systems of trauma care result in similar survival for older patients with serious injuries seen first at low-volume or high-volume hospitals.
Clark
David E
DE
Department of Surgery, Maine Medical Center, Portland, ME, USA. clarkd@mmc.org
DeLorenzo
Michael A
MA
Lucas
F L
FL
Cushing
Brad M
BM
D015998:Abbreviated Injury Scale; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012306:Risk; D015996:Survival Rate; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality* / Q000628:therapy*