title: Role of trauma team activation in poor outcomes of elderly patients.
abstract: Elderly trauma patients suffer worse outcomes than younger patients. Trauma team activation (TTA) improves outcomes in younger patients. It is unclear whether decreased TTA effectiveness or under-activation in elderly patients could contribute to their poor outcomes.
  
  
  
  This retrospective registry study examined all adult trauma patients admitted to a level 1 trauma center over 2 y. Analyses tested (1) whether age modifies the effect of TTA on poor outcomes, (2) whether elderly patients with severe injury were less likely to receive TTA than younger patients, and (3) which early variables were associated with poor outcomes among elderly patients who did not receive TTA.
  
  
  
  The study included 10,033 patients. The adjusted relative risk from TTA for all ages was 0.48 (95% confidence interval (CI) = 0.34-0.68, P < 0.001), and there was no effect modification by age (interaction term P value, 0.171). The adjusted odds ratio for the young was 0.49 (95% CI = 0.26-0.91, P = 0.024) and for the elderly was 0.80 (95% CI = 0.53-1.20, P = 0.282). The adjusted odds ratio for lack of TTA associated with old age was 1.37 (95% CI = 1.12-1.69, P = 0.003). The strongest associations with poor outcomes were seen with low heart rate, low minimum blood pressure, high injury severity score, and high Glasgow coma score.
  
  
  
  Lack of TTA could contribute to elderly patients' poor outcomes. Clinicians should not be reassured by normal heart rates and should be wary of even transiently lower blood pressures in the elderly. A large cohort study is needed to identify which additional elderly patients could benefit from TTA.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, University of Washington, Seattle, Washington. Electronic address: aestjohn@uw.edu.
authors.forename: Alexander E
authors.initials: AE
authors.lastname: St John
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington; Harborview Injury Prevention Center, Seattle, Washington.
authors.forename: Ali
authors.initials: A
authors.lastname: Rowhani-Rahbar
authors.affiliation: Division of Trauma, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
authors.affiliation: Division of Trauma, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration* / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration* / Q000706:statistics & numerical data; D014861:Washington; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
keywords: Elderly; Outcomes; Trauma team activation