Elderly patients often do not get the correct level of care for traumatic injuries because many are treated at facilities without specialized expertise in trauma care, according to data recently published in the Journal of American College of Surgeons.
“If we are not doing something right, this will continue to cost lives and dollars,” Kristan L. Staudenmayer, MD, MS, FACS, assistant professor of surgery at Stanford University School of Medicine, stated in an American College of Surgeons press release.
In a population-based, retrospective, cohort study of all injured adults aged 55 years or older in California and Utah, researchers linked prehospital data of 6,015 patients to trauma registry data, state level discharge data, emergency department records and death files. The primary outcomes included 60-day mortality. Researchers compared patients treated at trauma centers with patients treated at non-trauma centers. They defined undertriage as an Injury Severity Score (ISS) greater than 15 with transport to a non-trauma center.
Study results showed patients taken to non-trauma centers were older, more often female and less often had an ISS greater than 15. Researchers found 244 patients with an ISS greater than 15. The undertriage rate was 32.8%, according to study results.
When looking at 60-day mortality rate, researchers found a 17% rate of ISS greater than 15 with no difference between trauma and non-trauma centers in unadjusted or adjusted analyses. However, for severely injured patients taken to trauma centers, the median per-patient costs were $21,000 higher.
“When we are able to identify which patients actually benefit from trauma care, we will see fewer deaths in that subgroup,” Staudenmayer stated. “If we see elderly patients who have been on a steady physical decline, we can tell if the fall is a marker of poor outcomes or the cause. Then, we can save lives for some people or at least have a better discussion about how to proceed going forward.”
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Disclosure: Staudenmayer reports no relevant financial disclosures.
