TY - JOUR
T1 - Association of Trauma Center Designation with Postdischarge Survival among Older Adults with Injuries
AU - Jarman, Molly P.
AU - Jin, Ginger
AU - Weissman, Joel S.
AU - Ash, Arlene S.
AU - Tjia, Jennifer
AU - Salim, Ali
AU - Haider, Adil
AU - Cooper, Zara
N1 - Publisher Copyright:
© 2022 Jarman MP et al.
PY - 2022/3/16
Y1 - 2022/3/16
N2 - Importance: Trauma centers improve outcomes for young patients with serious injuries. 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. Objective: To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital's trauma center level. Design, 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. Data analysis was performed from January 1 to June 31, 2021. Preinjury health was measured using 2013 claims, and outcomes were measured through 2016. The population was stratified by anatomical injury pattern. 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. Exposure: Admitting hospital's trauma center level. 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. Results: A total of 433169 Medicare beneficiaries (mean [SD] age, 82.9 [8.3] years; 68.4% female; 91.5% White) were included in the analysis. A total of 206275 (47.6%) were admitted to non-trauma centers and 161492 (37.3%) to level I or II trauma centers. Patients with isolated extremity fracture had the fewest deaths (365-day CFR ranged from 16.1% [95% CI, 11.2%-22.4%] to 17.4% [95% CI, 11.8%-24.6%] by trauma center status). Patients with both hip fracture and traumatic brain injury had the most deaths (365-day CFRs ranged from 33.4% [95% CI, 25.8%-42.1%] to 35.8% [95% CI, 28.9%-43.5%]). Conclusions and Relevance: These findings suggest that older adults do not benefit from existing trauma center care, which is designed with younger patients in mind. There is a critical need to improve trauma care practices to address common injury mechanisms and types of injury in older adults.
AB - Importance: Trauma centers improve outcomes for young patients with serious injuries. 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. Objective: To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital's trauma center level. Design, 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. Data analysis was performed from January 1 to June 31, 2021. Preinjury health was measured using 2013 claims, and outcomes were measured through 2016. The population was stratified by anatomical injury pattern. 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. Exposure: Admitting hospital's trauma center level. 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. Results: A total of 433169 Medicare beneficiaries (mean [SD] age, 82.9 [8.3] years; 68.4% female; 91.5% White) were included in the analysis. A total of 206275 (47.6%) were admitted to non-trauma centers and 161492 (37.3%) to level I or II trauma centers. Patients with isolated extremity fracture had the fewest deaths (365-day CFR ranged from 16.1% [95% CI, 11.2%-22.4%] to 17.4% [95% CI, 11.8%-24.6%] by trauma center status). Patients with both hip fracture and traumatic brain injury had the most deaths (365-day CFRs ranged from 33.4% [95% CI, 25.8%-42.1%] to 35.8% [95% CI, 28.9%-43.5%]). Conclusions and Relevance: These findings suggest that older adults do not benefit from existing trauma center care, which is designed with younger patients in mind. There is a critical need to improve trauma care practices to address common injury mechanisms and types of injury in older adults.
UR - http://www.scopus.com/inward/record.url?scp=85126684076&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2022.2448
DO - 10.1001/jamanetworkopen.2022.2448
M3 - Article
C2 - 35294541
AN - SCOPUS:85126684076
SN - 2574-3805
VL - 5
JO - JAMA network open
JF - JAMA network open
IS - 3
M1 - e222448
ER -