Triage Among Elderly Trauma Patients

Triage Among Elderly Trauma Patients

Patients with the most severe injuries can be taken to trauma centers that offer immediate specialized resources. However, instead of going to a trauma center, many elderly patients receive care in facilities without specialized expertise in trauma care. Research has shown that elderly patients are frequently undertriaged, but little is known about the associations between triage patterns and outcomes. Analyzing Undertriage In a study published in the Journal of the American College of Surgeons, Kristan L. Staudenmayer, MD, MS, FACS, and colleagues assessed how undertriaging elderly patients affects outcomes and whether they survived an injury 60 days later. This time frame is important because elderly patients often die after leaving the hospital rather than during hospitalization. Using in-hospital mortality can underestimate the true impact of injuries in this population. The study group reviewed data from emergency medical services in California and Utah from 6,015 patients aged 55 and older. There were no significant differences in 60-day mortality between trauma centers and non-trauma centers for patients who were severely injured in both unadjusted and adjusted analyses. Unadjusted 60-day mortality rates were 16% to 17%. Despite the lack of mortality benefit, severely injured elderly patients treated at trauma centers incurred greater costs. After adjusting for patient and injury characteristics, the median costs for patients at trauma centers were approximately 20% higher than at non-trauma centers. “It’s known that elderly patients don’t do as well as the young after injuries, but it’s difficult to argue that this is purely due to undertriage,” says Dr. Staudenmayer.  “In analyzing all deaths in the elderly, we found that mortality was more commonly associated with falls...

Analyzing Outcomes for Adults Admitted to Trauma Centers

Over the past 2 decades, significant improvements in mortality outcomes have been observed in various conditions thanks to emphasizing the need for patients to receive recommended evidence-based care and treatments. Less attention, however, has been paid to outcomes resulting from trauma, even though it is the leading cause of potential lost years of life before the age of 65. “Trends in mortality among trauma patients have not been explored adequately in recent research,” says Turner M. Osler, MD, FACS. In an effort to fill this void, Dr. Osler and colleagues conducted a study to determine whether or not mortality rates have improved in trauma patients like they have in other disease states. Published in the Archives of Surgery, the analysis examined longitudinal trends in overall mortality of injured patients who were admitted to level I or level II trauma centers using registry data. A secondary analysis stratified the data by injury severity. Fewer Trauma Mortalities In the study, Dr. Osler and colleagues examined the medical records of nearly 209,000 patients admitted to EDs with injuries who were treated for trauma in 28 hospitals throughout Pennsylvania. Most patients involved in the study were men, but the proportion of patients with mild, moderate, and severe injuries was similar. Blunt trauma and car accidents were the most common causes of trauma, but gunshot wounds, low falls, pedestrian injuries, and stabbings were also reported in the data. “It’s likely that several factors may be responsible for helping people survive trauma.” When comparing 2000-2001 data with that from 2008-2009, the overall mortality rate for patients with moderate injuries decreased by 29% (Figure), and the...