The relationship between processes and outcomes for injured older adults: a study of a statewide trauma system.
OBJECTIVE
Age is a risk factor for death, adverse outcomes, and health care use following trauma. The American College of Surgeons' Trauma Quality Improvement Program (TQIP) has published "best practices" of geriatric trauma care; adoption of these guidelines is unknown. We sought to determine which evidence-based geriatric protocols, including TQIP guidelines, were correlated with decreased mortality in Pennsylvania's trauma centers.


METHODS
PA's level I and II trauma centers self-reported adoption of geriatric protocols. Survey data were merged with risk-adjusted mortality data for patients ≥65 from a statewide database, the Pennsylvania Trauma Systems Foundation (PTSF), to compare mortality outlier status and processes of care. Exposures of interest were center-specific processes of care; outcome of interest was PTSF mortality outlier status.


RESULTS
26 of 27 eligible trauma centers participated. There was wide variation in care processes. Four trauma centers were low outliers; three centers were high outliers for risk-adjusted mortality rates in adults ≥65. Results remained consistent when accounting for center volume. The only process associated with mortality outlier status was age-specific solid organ injury protocols (p = 0.04). There was no cumulative effect of multiple evidence-based processes on mortality rate (p = 0.50).


CONCLUSIONS
We did not see a link between adoption of geriatric best-practices trauma guidelines and reduced mortality at PA trauma centers. The increased susceptibility of elderly to adverse consequences of injury, combined with the rapid growth rate of this demographic, emphasizes the importance of identifying interventions tailored to this population.


METHODS
III.


METHODS
Descriptive.
Department of Surgery, Harvard School of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Saillant
Perelman School of Medicine at the University of Pennsylvania, 2400 Chestnut St., Apt 1907, Philadelphia, PA, 19103, USA. eearl@mail.med.upenn.edu.
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E
Earl-Royal
Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J L
JL
Pascual
Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
S R
SR
Allen
Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
P K
PK
Kim
Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
M K
MK
Delgado
Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
B G
BG
Carr
Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
D
D
Wiebe
Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
D N
DN
Holena
D000368:Aged; D002985:Clinical Protocols; D005260:Female; D005853:Geriatrics / Q000592:standards*; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010414:Pennsylvania / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality*
Geriatric; Mortality; Outcomes assessment; Trauma Quality Improvement Program (TQIP); Treatment protocols