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

This study aimed to compare the quality metrics for resuscitative measures and outcomes of severely injured geriatric trauma patients (GTPs) requiring hemorrhage control surgery between trauma centers with high geriatric volume (HV GTC) and trauma centers with high adult volume (HV ATC).

This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database (2017-2021). We included GTPs (≥65 y) with severe injuries (ISS ≥ 16) and a shock index (SI) of >1, who underwent one of the main hemorrhage control surgeries, including laparotomy, thoracotomy, sternotomy, and extremity surgeries. Trauma centers (TCs) were stratified based on the annual number of geriatric and adult patients into low-(LV), medium-(MV), and high-volume (HV) GTCs and HV ATC and compared.

A total of 1937 severely injured GTPs managed at 416 TCs (174 LV GTC; 143 MV GTC; 62 HV GTC; 37 HV ATC) were identified. There was no significant difference among study groups in terms of patients' age (P = 0.076), shock index (P = 0.425), or injury severity (P = 0.412). Overall, GTPs who were treated at HV ATCs had a shorter time to blood transfusion, time to whole blood transfusion, time to hemorrhage control surgery, and more balanced transfusion, compared to LV, MV, and HV GTCs. On multivariable regression analysis, HV ATCs were independently associated with decreased 24-h mortality (adjusted odds ratio: 0, P = 0.033) and in-hospital mortality (adjusted odds ratio: 0.72, P = 0.027), compared to HV GTCs.

Although HV ATCs demonstrated shorter times to intervention and lower mortality compared with GTCs, these findings should be interpreted within the context of an observational study. The findings of this study highlight the room for improvement of HV GTCs in terms of early aggressive resuscitation of severely injured older adults. Future prospective studies are warranted to validate these results and to explore opportunities for protocol standardization at GTCs to improve outcomes.