Faculty Collaboration Database

The relationship between processes and outcomes for injured older adults: a study of a statewide trauma system. Eur J Trauma Emerg Surg 2017 Feb;43(1):121-127

Date

10/30/2015

Pubmed ID

26510941

Pubmed Central ID

PMC4848193

DOI

10.1007/s00068-015-0586-9

Scopus ID

2-s2.0-84945560428 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

PURPOSE: 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.

LEVEL OF EVIDENCE: III.

STUDY TYPE: Descriptive.

Author List

Saillant NN, Earl-Royal E, Pascual JL, Allen SR, Kim PK, Delgado MK, Carr BG, Wiebe D, Holena DN

Author

Daniel N. Holena MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Clinical Protocols
Female
Geriatrics
Humans
Male
Pennsylvania
Practice Guidelines as Topic
Trauma Centers
Wounds and Injuries