Improving mortality in older adult trauma patients: Are we doing better? J Trauma Acute Care Surg 2022 Feb 01;92(2):413-421
Date
09/24/2021Pubmed ID
34554138DOI
10.1097/TA.0000000000003406Scopus ID
2-s2.0-85123878192 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Older adult trauma is associated with high morbidity and mortality. Individuals older than 65 years are expected to make up more than 21% of the total population and almost 39% of trauma admissions by 2050. Our objective was to perform a national review of older adult trauma mortality and identify associated risk factors to highlight potential areas for improvement in quality of care.
MATERIALS AND METHODS: This is a retrospective cohort study of the National Trauma Data Bank including all patients age ≥65 years with at least one International Classification of Diseases, Ninth Revision, Clinical Modification trauma code admitted to a Level I or II US trauma center between 2007 and 2015. Variables examined included demographics, comorbidities, emergency department vitals, injury characteristics, and trauma center characteristics. Multilevel mixed-effect logistic regression was performed to identify independent risk factors of in-hospital mortality.
RESULTS: There were 1,492,759 patients included in this study. The number of older adult trauma patients increased from 88,056 in 2007 to 158,929 in 2015 (p > 0.001). Adjusted in-hospital mortality decreased in 2014 to 2015 (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.86-0.91) when compared with 2007 to 2009. Admission to a university hospital was protective (OR, 0.83; 95% CI, 0.74-0.93) as compared with a community hospital admission. There was no difference in mortality risk between Level II and Level I admission (OR, 1.00; 95% CI, 0.92-1.08). The strongest trauma-related risk factor for in-patient mortality was pancreas/bowel injury (OR, 2.25; 95% CI, 2.04-2.49).
CONCLUSION: Mortality in older trauma patients is decreasing over time, indicating an improvement in the quality of trauma care. The outcomes of university based hospitals can be used as national benchmarks to guide quality metrics.
LEVEL OF EVIDENCE: Therapeutic/Care Management, Level IV.
Author List
Karam BS, Patnaik R, Murphy P, deRoon-Cassini TA, Trevino C, Hemmila MR, Haines K, Puzio TJ, Charles A, Tignanelli C, Morris RAuthors
Rachel S. Morris MD Assistant Professor in the Surgery department at Medical College of WisconsinPatrick Murphy MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Colleen Trevino PhD Assistant Professor in the Surgery department at Medical College of Wisconsin
Terri A. deRoon Cassini PhD Center Director, Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Databases, Factual
Female
Hospital Mortality
Humans
Male
Retrospective Studies
Risk Factors
United States
Wounds and Injuries
