Understanding Failure to Rescue in Geriatric Trauma: A National Analysis of Predictors and Outcomes

Area of Science:

• Trauma Surgery
• Geriatric Medicine
• Quality Improvement

Background:

• Failure to rescue (FTR), defined as mortality following major complications, is a critical quality metric in medicine.
• Geriatric trauma patients represent a vulnerable population with unique care needs.

Purpose of the Study:

• To evaluate temporal trends in FTR among geriatric trauma patients.
• To identify predictors and disparities associated with FTR in this demographic.
• To analyze FTR using a national trauma database.

Main Methods:

• Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program (2017-2021).
• Inclusion of patients aged 65+ with major complications; FTR defined as in-hospital mortality post-complication.
• Analysis of demographic, clinical variables (ISS, mFI), insurance status, trauma center level, and temporal trends.

Main Results:

• Overall FTR rate was 44.5%, increasing annually from 41.8% (2017) to 47.2% (2021).
• Predictors of FTR included older age, higher Injury Severity Score (ISS), and treatment at Level II/III trauma centers.
• Observed disparities: higher FTR odds for Asian, Black, Hispanic patients, and those with public insurance (Medicaid/Medicare).

Conclusions:

• FTR rates significantly increased in geriatric trauma patients over time.
• Identified key predictors (age, ISS, trauma center level) and disparities (race, insurance status).
• Recommendations include improving access to high-level trauma centers and refining care protocols to mitigate FTR risk.