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Defining geriatric trauma: when does age make a difference?
Nicholas W Goodmanson1, Matthew R Rosengart, Amber E Barnato
1Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Insights
Mortality risk in injured patients significantly increases starting at age 57. Trauma center (TC) care improves outcomes for older patients, suggesting an age threshold for TC triage is warranted.
Area of Science:
- Trauma Surgery
- Geriatric Medicine
- Public Health Policy
Background:
- Elderly patients are undertriaged to trauma centers (TCs).
- Defining the geriatric trauma patient age threshold is debated.
- This study investigates age-related mortality risk and TC care effectiveness.
Purpose of the Study:
- Identify the age at which mortality risk increases due to age alone.
- Determine if TC care improves outcomes for older injured patients.
- Estimate the impact of an age threshold on TC admissions.
Main Methods:
- Retrospective cohort study of injured patients (age 19-100) in Pennsylvania (2001-2005).
- Included patients with minimal injury (Injury Severity Score < 9).
- Analyzed in-hospital mortality and age as a predictor using fractional polynomial method.
Main Results:
- Mortality risk significantly increased at age 57 (OR 5.58).
- TC care was associated with decreased mortality risk (OR 0.83).
- An age threshold of 70 for triage would add ~1 admission/day to TCs.
Conclusions:
- Age is a significant mortality risk factor in trauma.
- TC care benefits older, minimally injured patients.
- Consider an age threshold (e.g., 70) for TC triage to improve outcomes without substantial admission increase.
Background:
Injured elderly patients experience high rates of undertriage to trauma centers (TCs) whereas debate continues regarding the age defining a geriatric trauma patient. We sought to identify when mortality risk increases in injured patients as the result of age alone to determine whether TC care was associated with improved outcomes for these patients and to estimate the added admissions burden to TCs using an age threshold for triage.
Methods:
We performed a retrospective cohort study of injured patients treated at TCs and non-TCs in Pennsylvania from April 1, 2001, to March 31, 2005. Patients were included if they were between 19 and 100 years of age and had sustained minimal injury (Injury Severity Score < 9). The primary outcome was in-hospital mortality. We analyzed age as a predictor of mortality by using the fractional polynomial method.
Results:
A total of 104,015 patients were included. Mortality risk significantly increased at 57 years (odds ratio 5.58; 95% confidence interval 1.07-29.0; P = .04) relative to 19-year-old patients. TC care was associated with a decreased mortality risk compared with non-TC care (odds ratio 0.83; 95% confidence interval 0.69-0.99; P = .04). Using an age of 70 as a threshold for mandatory triage, we estimated TCs could expect an annual increase of approximately one additional admission per day.
Conclusion:
Age is a significant risk factor for mortality in trauma patients, and TC care improves outcomes even in older, minimally injured patients. An age threshold should be considered as a criterion for TC triage. Use of the clinically relevant age of 70 as this threshold would not impose a substantial increase on annual TC admissions.
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