Document Detail

Defining geriatric trauma: when does age make a difference?
MedLine Citation:
PMID:  23021136     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Injured elderly patients experience high rates of undertriage to trauma centers (TCs) whereas debate continues regarding the age defining a geriatric trauma patient. We sought to identify when mortality risk increases in injured patients as the result of age alone to determine whether TC care was associated with improved outcomes for these patients and to estimate the added admissions burden to TCs using an age threshold for triage.
METHODS: We performed a retrospective cohort study of injured patients treated at TCs and non-TCs in Pennsylvania from April 1, 2001, to March 31, 2005. Patients were included if they were between 19 and 100 years of age and had sustained minimal injury (Injury Severity Score < 9). The primary outcome was in-hospital mortality. We analyzed age as a predictor of mortality by using the fractional polynomial method.
RESULTS: A total of 104,015 patients were included. Mortality risk significantly increased at 57 years (odds ratio 5.58; 95% confidence interval 1.07-29.0; P = .04) relative to 19-year-old patients. TC care was associated with a decreased mortality risk compared with non-TC care (odds ratio 0.83; 95% confidence interval 0.69-0.99; P = .04). Using an age of 70 as a threshold for mandatory triage, we estimated TCs could expect an annual increase of approximately one additional admission per day.
CONCLUSION: Age is a significant risk factor for mortality in trauma patients, and TC care improves outcomes even in older, minimally injured patients. An age threshold should be considered as a criterion for TC triage. Use of the clinically relevant age of 70 as this threshold would not impose a substantial increase on annual TC admissions.
Nicholas W Goodmanson; Matthew R Rosengart; Amber E Barnato; Jason L Sperry; Andrew B Peitzman; Gary T Marshall
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  152     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-01     Completed Date:  2012-12-13     Revised Date:  2014-06-27    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  668-74; discussion 674-5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mosby, Inc. All rights reserved.
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MeSH Terms
Age Factors
Aged, 80 and over
Cohort Studies
Middle Aged
Patient Admission
Pennsylvania / epidemiology
Practice Guidelines as Topic
Retrospective Studies
Risk Factors
Trauma Centers
Trauma Severity Indices
Wounds and Injuries / epidemiology,  mortality,  therapy*
Young Adult
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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