Resuscitation in Geriatric Trauma: Does Volume-Outcome Relationship Still Hold?

Area of Science:

• Trauma Surgery
• Geriatric Medicine
• Health Services Research

Background:

• Severely injured geriatric trauma patients (GTPs) require specialized care for hemorrhage control.
• Comparing outcomes between high-volume geriatric trauma centers (HV GTCs) and high-volume adult trauma centers (HV ATCs) is crucial for optimizing care.
• Quality metrics for resuscitation and surgical outcomes in GTPs need evaluation.

Purpose of the Study:

• To compare quality metrics and outcomes for severely injured GTPs undergoing hemorrhage control surgery.
• To evaluate differences in care between HV GTCs and HV ATCs.
• To identify areas for improvement in geriatric trauma care.

Main Methods:

• Retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database (2017-2021).
• Inclusion of geriatric trauma patients (≥65 years) with severe injuries (ISS ≥ 16) and shock index >1 undergoing major hemorrhage control surgeries.
• Stratification of trauma centers into low-, medium-, and high-volume geriatric centers (LV GTC, MV GTC, HV GTC) and HV ATCs for comparison.

Main Results:

• No significant differences in patient age, shock index, or injury severity across center types.
• GTPs treated at HV ATCs experienced shorter times to blood transfusion, whole blood transfusion, and hemorrhage control surgery.
• HV ATCs were independently associated with decreased 24-hour and in-hospital mortality compared to HV GTCs.

Conclusions:

• HV ATCs demonstrate superior outcomes in terms of timely interventions and reduced mortality for severely injured GTPs.
• Findings suggest a need for improvement in early, aggressive resuscitation protocols at HV GTCs.
• Further prospective studies are recommended to validate findings and standardize protocols for geriatric trauma care.