![]() ![]() 2 Although the association between age and injury mortality is well documented, 3, 4 it remains unclear whether older adults benefit from TC care as much as younger patients, particularly in the context of injury from low-energy, blunt mechanisms most common among older adults.Įvidence supporting TC care for older adults is outdated or limited in terms of generalizability to the full range of patients covered by current guidelines. 1 National guidelines recommend trauma center (TC) care for injured older adults when possible, 2 based on evidence that younger, critically injured patients benefit from TC care, risk of death after injury increases with age, and emergency medical services (EMS) personnel may underestimate injury severity in older adults. Nearly 3 000 000 US older adults experience traumatic injury each year, resulting in 50 000 deaths and $19 billion in lifetime health care costs for survivors. There is a critical need to improve trauma care practices to address common injury mechanisms and types of injury in older adults. Patients with both hip fracture and traumatic brain injury had the most deaths (365-day CFRs ranged from 33.4% to 35.8% ).Ĭonclusions and Relevance These findings suggest that older adults do not benefit from existing trauma center care, which is designed with younger patients in mind. Patients with isolated extremity fracture had the fewest deaths (365-day CFR ranged from 16.1% to 17.4% by trauma center status). ![]() A total of 206 275 (47.6%) were admitted to non-trauma centers and 161 492 (37.3%) to level I or II trauma centers. Results A total of 433 169 Medicare beneficiaries (mean age, 82.9 years 68.4% female 91.5% White) were included in the analysis. Main Outcomes and Measures Case fatality rates (CFRs) at 30 and 365 days after injury, estimated in the matched sample using multivariable, hierarchical logistic regression models. Propensity scores for level I trauma center treatment were estimated using the Abbreviated Injury Scale, age, and residential proximity to trauma center and then used to match beneficiaries from each trauma level (I, II, III, and IV/non-trauma centers) by injury type.Įxposure Admitting hospital’s trauma center level. The population was stratified by anatomical injury pattern. Preinjury health was measured using 2013 claims, and outcomes were measured through 2016. Data analysis was performed from January 1 to June 31, 2021. Objective To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital’s trauma center level.ĭesign, Setting, and Participants This prospective, population-based cohort study used Medicare claims data from January 1, 2013, to December 31, 2016, for all fee-for-service Medicare beneficiaries 66 years or older with inpatient admission for traumatic injury in 2014 to 2015. However, most injury-related hospital admissions and deaths occur in older adults, and it is not clear whether trauma center care provides the same benefit in this population. Importance Trauma centers improve outcomes for young patients with serious injuries. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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