title: Geriatric outcomes for trauma patients in the state of Florida after the advent of a large trauma network.
abstract: BACKGROUND
  Florida State has one of the largest geriatric populations in the United States. However, recent data show that up to the year 2010, geriatric trauma patients were least served by designated trauma centers (TCs). One existing TC and five provisional Level 2 TCs were combined to create a large-scale trauma network (TN). The new TCs were placed in those areas with the lowest ratios of TC to residents based on census data. The aim of this study was to measure the TN impact on the population of geriatric trauma patients.
  
  
  METHODS
  Data from the Florida State Agency for Health Care Administration were used to determine mortality, length of stay, and complication rates for geriatric trauma patients (≥ 65 years). The potential effect of the TN was measured by comparing outcomes before and after the initiation of the TN. A total of 165,640 geriatric patients were evaluated. Multivariate regression methods were used to match and adjust for age, injury status (penetrating vs. nonpenetrating), sex, race, comorbidity, and injury severity (DRG International Classification of Diseases-9th Rev. Injury Severity Score).
  
  
  RESULTS
  Since the advent of the TN, an additional 1,711 geriatric patients were treated compared with the previous period. The TN was responsible 86% of these new patients. There was a temporal association with a decrease in both mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.85-0.96) and length of stay (p < 0.0001) for geriatric patients since the advent of the TN. The improved access was associated with a significant decrease in mortality in the regions serviced by the TN.
  
  
  CONCLUSIONS
  Geriatric patients make up a significant proportion of trauma patients within the TN. The temporal improvement in outcomes may be associated with the increased proportion of patients being treated in state-designated TCs as a result of the addition of the TN.
  
  
  METHODS
  Epidemiologic study, level III.
authors: From Ocala Regional Medical Center, Ocala, Florida.
authors: Darwin
authors: D
authors: Ang
authors: Scott
authors: S
authors: Norwood
authors: Erik
authors: E
authors: Barquist
authors: Mark
authors: M
authors: McKenney
authors: Stanley
authors: S
authors: Kurek
authors: Brian
authors: B
authors: Kimbrell
authors: Alejandro
authors: A
authors: Garcia
authors: Charles B
authors: CB
authors: Walsh
authors: Huazhi
authors: H
authors: Liu
authors: Michele
authors: M
authors: Ziglar
authors: James
authors: J
authors: Hurst
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005431:Florida / Q000453:epidemiology; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration; D014947:Wounds and Injuries / Q000401:mortality*; D014949:Wounds, Nonpenetrating / Q000401:mortality; D014950:Wounds, Penetrating / Q000401:mortality