Skip to main content

Improving mortality in older adult trauma patients: Are we doing better?

Publication ,  Journal Article
Karam, BS; Patnaik, R; Murphy, P; deRoon-Cassini, TA; Trevino, C; Hemmila, MR; Haines, K; Puzio, TJ; Charles, A; Tignanelli, C; Morris, R
Published in: J Trauma Acute Care Surg
February 1, 2022

BACKGROUND: Older adult trauma is associated with high morbidity and mortality. Individuals older than 65 years are expected to make up more than 21% of the total population and almost 39% of trauma admissions by 2050. Our objective was to perform a national review of older adult trauma mortality and identify associated risk factors to highlight potential areas for improvement in quality of care. MATERIALS AND METHODS: This is a retrospective cohort study of the National Trauma Data Bank including all patients age ≥65 years with at least one International Classification of Diseases, Ninth Revision, Clinical Modification trauma code admitted to a Level I or II US trauma center between 2007 and 2015. Variables examined included demographics, comorbidities, emergency department vitals, injury characteristics, and trauma center characteristics. Multilevel mixed-effect logistic regression was performed to identify independent risk factors of in-hospital mortality. RESULTS: There were 1,492,759 patients included in this study. The number of older adult trauma patients increased from 88,056 in 2007 to 158,929 in 2015 (p > 0.001). Adjusted in-hospital mortality decreased in 2014 to 2015 (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.86-0.91) when compared with 2007 to 2009. Admission to a university hospital was protective (OR, 0.83; 95% CI, 0.74-0.93) as compared with a community hospital admission. There was no difference in mortality risk between Level II and Level I admission (OR, 1.00; 95% CI, 0.92-1.08). The strongest trauma-related risk factor for in-patient mortality was pancreas/bowel injury (OR, 2.25; 95% CI, 2.04-2.49). CONCLUSION: Mortality in older trauma patients is decreasing over time, indicating an improvement in the quality of trauma care. The outcomes of university based hospitals can be used as national benchmarks to guide quality metrics. LEVEL OF EVIDENCE: Therapeutic/Care Management, Level IV.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

February 1, 2022

Volume

92

Issue

2

Start / End Page

413 / 421

Location

United States

Related Subject Headings

  • Wounds and Injuries
  • United States
  • Risk Factors
  • Retrospective Studies
  • Male
  • Humans
  • Hospital Mortality
  • Female
  • Emergency & Critical Care Medicine
  • Databases, Factual
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Karam, B. S., Patnaik, R., Murphy, P., deRoon-Cassini, T. A., Trevino, C., Hemmila, M. R., … Morris, R. (2022). Improving mortality in older adult trauma patients: Are we doing better? J Trauma Acute Care Surg, 92(2), 413–421. https://doi.org/10.1097/TA.0000000000003406
Karam, Basil S., Rohan Patnaik, Patrick Murphy, Terri A. deRoon-Cassini, Colleen Trevino, Mark R. Hemmila, Krista Haines, et al. “Improving mortality in older adult trauma patients: Are we doing better?J Trauma Acute Care Surg 92, no. 2 (February 1, 2022): 413–21. https://doi.org/10.1097/TA.0000000000003406.
Karam BS, Patnaik R, Murphy P, deRoon-Cassini TA, Trevino C, Hemmila MR, et al. Improving mortality in older adult trauma patients: Are we doing better? J Trauma Acute Care Surg. 2022 Feb 1;92(2):413–21.
Karam, Basil S., et al. “Improving mortality in older adult trauma patients: Are we doing better?J Trauma Acute Care Surg, vol. 92, no. 2, Feb. 2022, pp. 413–21. Pubmed, doi:10.1097/TA.0000000000003406.
Karam BS, Patnaik R, Murphy P, deRoon-Cassini TA, Trevino C, Hemmila MR, Haines K, Puzio TJ, Charles A, Tignanelli C, Morris R. Improving mortality in older adult trauma patients: Are we doing better? J Trauma Acute Care Surg. 2022 Feb 1;92(2):413–421.

Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

February 1, 2022

Volume

92

Issue

2

Start / End Page

413 / 421

Location

United States

Related Subject Headings

  • Wounds and Injuries
  • United States
  • Risk Factors
  • Retrospective Studies
  • Male
  • Humans
  • Hospital Mortality
  • Female
  • Emergency & Critical Care Medicine
  • Databases, Factual