title: Assessment of mortality in older trauma patients sustaining injuries from falls or motor vehicle collisions treated in regional level I trauma centers.
abstract: OBJECTIVE
  To compare mortality in elderly trauma patients sustaining fall or motor vehicle collision (MVC) related injuries and who are subsequently treated at regional Level I (tertiary) trauma centers.
  
  
  BACKGROUND
  An increase in the mean age of the Canadian population is leading to a higher proportion of older patients injured in falls who are subsequently treated at Level 1 trauma centers in Quebec. The Level 1 centers were designed to treat younger patients injured in MVCs and violent acts. As a result, discordance may exist between the type of care supplied at these centers and the increased demand for care tailored to older trauma patients.
  
  
  METHODS
  A retrospective cohort study comprised of 4,717 patients over the age of 65; 606 (12.8%) injured in MVCs and 4,111 (87.2%) in falls. The mean (SD) age was 79.6 (8.0) years and 67.9% were female. The mean (SD) Injury Severity Score (ISS) was 10.8 (7.4). Data were obtained from the Quebec Trauma Registry (QTR) for patients treated at 3 Level I trauma centers in the province of Quebec, Canada. The primary outcome measure in this study was mortality.
  
  
  RESULTS
  Being injured in a fall was a strong predictor for mortality, with an odds ratio of 5.11 (95% C.I. = 1.84-14.17, P = 0.002). Additionally, the adjusted mortality rate was 25.3% among fall victims, versus 7.8% for MVC patients. Female gender, older age, higher ISS and an increasing number of injuries were all associated with heightened mortality. In contrast, the number of body regions injured, experiencing complications, sustaining a hip fracture, the Revised Trauma Score, the Prehospital Index and the Charlson (comorbidity) Index had no association with mortality in the Level I centers.
  
  
  CONCLUSIONS
  Elderly patients sustaining fall-related injuries and treated at Level I trauma centers are at risk for excess mortality when compared with those injured in MVCs. Effective and efficient methods for treating this population must be determined.
authors.affiliation: Department of Surgery, Surgical Research, McGill University, Montreal, Quebec, Canada. jsampalis@jssresearch.com
authors.forename: John S
authors.initials: JS
authors.lastname: Sampalis
authors.forename: Robin
authors.initials: R
authors.lastname: Nathanson
authors.forename: Julie
authors.initials: J
authors.lastname: Vaillancourt
authors.forename: Andreas
authors.initials: A
authors.lastname: Nikolis
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.forename: John
authors.initials: J
authors.lastname: Angelopoulos
authors.forename: Nickolaos
authors.initials: N
authors.lastname: Krassakopoulos
authors.forename: Nadia
authors.initials: N
authors.lastname: Longo
authors.forename: Eliofotisti
authors.initials: E
authors.lastname: Psaradellis
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000401:mortality*