Direct transport of geriatric trauma patients with pelvic fractures to a Level I trauma center within an organized trauma system: impact on two-week incidence of in-hospital complications.
BACKGROUND
Undertriage of elderly trauma patients to tertiary trauma centers is well documented. This study evaluated the impact of directness of transport to a Level I trauma center on morbidity in geriatric trauma patients sustaining severe pelvic fractures.


METHODS
This was a retrospective cohort study of 87 geriatric trauma patients diagnosed with potentially unstable pelvic fractures, treated at a Level I trauma center between 2008 and 2010.


RESULTS
Of the 87 patients, 39% (34 of 87) initially were transported to a nontertiary trauma center. After adjusting for presence of comorbidity and injury severity, the 2-week incidence of complications was 54% higher in transferred patients compared with those directly transported (rate ratio, 1.54; 95% confidence interval, .95-2.54). In particular, transferred patients had increased odds of developing pneumonia/systemic inflammatory response syndrome.


CONCLUSIONS
Despite lacking precision, results of this study suggest an increased risk of complications in transferred geriatric trauma patients with severe pelvic fractures compared with their directly transported counterparts.
Department of Surgery, University of Oklahoma College of Medicine, 920 Stanton L. Young Blvd., Williams Pavilion Building, Rm 2140, Oklahoma City, OK 73104, USA.
Tabitha
T
Garwe
Zachary V
ZV
Roberts
Roxie M
RM
Albrecht
Ashley E
AE
Morgan
Jeremy J
JJ
Johnson
Barbara R
BR
Neas
D015998:Abbreviated Injury Scale; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005592:Fracture Fixation; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D010384:Pelvic Bones / Q000293:injuries*; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D016012:Poisson Distribution; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000209:etiology; D014187:Transportation of Patients; D014193:Trauma Centers; D014218:Triage