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Trauma centre outcome performance: a comparison of young adults and geriatric patients in an inclusive trauma system
Lynne Moore1, Alexis F Turgeon, Marie-Josée Sirois
1Unite de Traumatologie-Urgence-Soins Intensifs, Centre de Recherche du CHA, Hôpital de l'Enfant-Jésus, Université Laval, Quebec City, Quebec, Canada. lynne.moore.cha@ssss.gouv.qc.ca
Insights
Trauma center performance for young adults does not predict outcomes for geriatric patients. Elderly patients with severe head injuries are also less likely to be transferred to specialized neurosurgical trauma centers.
Area of Science:
- Trauma care research
- Geriatric medicine
- Health services research
Background:
- Elderly trauma patients require specialized care but lack standardized strategies within trauma systems.
- Existing trauma systems may not effectively cater to the unique needs of geriatric patients.
- Variations in trauma center performance for younger adults may not translate to older populations.
Purpose of the Study:
- To evaluate if trauma centers with lower/higher than expected mortality in patients <65 years have similar outcomes for geriatric patients.
- To compare transfer rates to level I/II trauma centers across different age groups.
- To identify potential disparities in trauma care for elderly individuals.
Main Methods:
- Analysis of a Canadian provincial trauma registry (1999-2006).
- Risk-adjusted 30-day mortality estimates for 57 adult trauma centers.
- Correlation coefficients used to assess agreement in performance between age groups.
Main Results:
- The study included 55,283 young adults (3.5% mortality) and 30,960 geriatric patients (8.2% mortality).
- Hospital performance ranks for young adults and geriatric patients were largely uncorrelated (r=0.01).
- Geriatric patients with severe head injuries were less likely to be transferred to level I/II centers (71%) compared to young adults (81%).
Conclusions:
- Trauma center performance in young adults does not reliably predict outcomes for geriatric patients.
- Geriatric trauma patients, particularly those with severe head injuries, face disparities in access to specialized neurosurgical trauma centers.
- Further research is essential to understand and address inter-hospital variations in outcomes for geriatric trauma patients.
Background:
Elderly trauma patients represent a unique clientele requiring specialised care but they rarely benefit from standardised care strategies within trauma systems. We aimed to evaluate whether trauma centres with lower/higher than expected mortality amongst patients <65 years of age have similar results for geriatric patients. A secondary objective was to compare transfer to level I/II trauma centres across age groups.
Methods:
The study was based on data from a Canadian provincial trauma registry (1999-2006). Outcome performance was evaluated with estimates of risk-adjusted 30-day mortality generated for each of the system's 57 adult trauma centres. Agreement in performance results was evaluated with correlation coefficients.
Results:
The study sample comprised 55,283 young adults (3.5% mortality) and 30,960 geriatric patients (8.2% mortality). The two age groups only had one out of six outliers in common. Hospital ranks amongst young adults were not correlated to those assigned amongst geriatric patients (r = 0.01, 95%CI -0.25;0.27). Correlation was also low for patients with major trauma (r = 0.20, 95%CI -0.06;0.44). Amongst patients with severe head injuries initially received in a level III/IV centre, 81% of young adults versus 71% of geriatric patients were transferred to a level I/II centre (p<0.0001).
Conclusions:
Trauma centres that have low risk-adjusted mortality for young adults do not necessarily do so for geriatric patients. In addition, geriatric patients with severe head injuries are less likely to be treated in neurosurgical trauma centres. Further research is needed to identify determinants of inter-hospital variation in outcome for geriatric trauma patients.
