Trauma teams show no difference in effectiveness but are less frequently activated in elderly patients compared to younger patients
St. John, Alexander
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Background Elderly patients have been found to suffer worse outcomes compared to their younger counterparts. Trauma team activation (TTA) is an intervention known to improve outcomes of seriously injured younger patients, but the effect of TTA on elderly patients is not well-studied. It is also not clear whether elderly trauma patients are being under-triaged and trauma teams are being under-activated for this population. Methods This was a retrospective database study examining all adult trauma patients admitted to a single Level 1 trauma center over a 2-year period. First, using a cohort analysis, it was tested whether old age modifies the effect of TTA seen in younger patients on poor outcomes (defined as in-hospital death or discharge to skilled nursing facility). Second, using a case-control analysis, it was tested whether elderly patients with severe injury were less likely to receive TTA than their younger counterparts. For this analysis, cases were defined as patients with a serious injury (defined as the composite outcome of death, receiving a blood transfusion, ED disposition to OR in the first 4 hours, or ED disposition to ICU) who did not receive TTA, while controls were all patients with serious injury who did receive TTA. Finally, a secondary analysis examined what physiologic and mechanism-based variables were associated with poor outcomes among elderly patients who did not receive TTA. Results A total of 10,033 patients met inclusion criteria. The cohort analysis showed an adjusted relative risk associated with TTA of 0.18 (95% CI: 0.03 – 0.91, p=0.038), and the effect modification from old age was not significant at 2.74 (95% CI: 0.46 – 16.40, p=0.269). The case-control analysis showed an adjusted odds ratio for lack of TTA associated with old age of 1.37 (95% CI: 1.12 – 1.69, p = 0.003). This effect was largely due to patients with blunt and fall injuries. The secondary analysis showed the strongest associations with poor outcome for blunt and burn injuries, low chest abbreviated injury score (AIS), and high upper extremity AIS. Conclusions Lack of TTA, particularly in blunt and fall injuries, is likely a contributing factor to the poor outcomes seen in elderly trauma patients. Among elderly patients not already receiving TTA, there was a higher risk of poor outcomes associated with blunt and burn injuries, low chest AIS, and high upper extremity AIS. This study lends support to the addition of a TTA criterion for low-mechanism falls in the elderly.
- Epidemiology