Outcomes of trauma care at centers treating a higher proportion of older patients: the case for geriatric trauma centers.
BACKGROUND
The burden of injury among older patients continues to grow and accounts for a disproportionate number of trauma deaths. We wished to determine if older trauma patients have better outcomes at centers that manage a higher proportion of older trauma patients.


METHODS
The National Trauma Data Bank years 2007 to 2011 was used. All high-volume Level 1 and Level 2 trauma centers were included. Trauma centers were categorized by the proportion of older patients seen. Adult trauma patients were categorized as older (≥65 years) and younger adults (16-64 years). Coarsened exact matching was used to determine differences in mortality and length of stay between older and younger adults. Risk-adjusted mortality ratios by proportion of older trauma patients seen were analyzed using multivariate logistic regression models and observed-expected ratios.


RESULTS
A total of 1.9 million patients from 295 centers were included. Older patients accounted for one fourth of trauma visits. Matched analysis revealed that older trauma patients were 4.2 times (95% confidence interval, 3.99-4.50) more likely to die than younger patients. Older patients were 34% less likely to die if they presented at centers treating a high versus low proportion of older trauma (odds ratio, 0.66; 95% confidence interval, 0.54-0.81). These differences were independent of trauma center performance.


CONCLUSIONS
Geriatric trauma patients treated at centers that manage a higher proportion of older patients have improved outcomes. This evidence supports the potential advantage of treating older trauma patients at centers specializing in geriatric trauma.


METHODS
Prognostic and epidemiologic study, level III.
From the Department of Surgery (S.N.Z., A.O., W.R.G., E.E.C.), Howard University Hospital, Washington, District of Columbia; Center for Surgical Trials and Outcomes Research (E.B.S., V.K.S., D.T.E.), School of Medicine, and Bloomberg School of Public Health (E.J.M.), John Hopkins University, Baltimore, Maryland; Department of General Surgery (Z.G.H.), Sinai Hospital Baltimore, MD; Center for Surgery and Public Health Harvard Medical School; Harvard School of Public Health; and Department of Surgery (A.H.H.), Brigham and Women's Hospital, Boston, MA.
Syed Nabeel
SN
Zafar
Augustine
A
Obirieze
Eric B
EB
Schneider
Zain G
ZG
Hashmi
Valerie K
VK
Scott
Wendy R
WR
Greene
David T
DT
Efron
Ellen J
EJ
MacKenzie
Edward E
EE
Cornwell
Adil H
AH
Haider
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D014193:Trauma Centers