Citation

Nguyen JK, Sanghavi P. Health Serv. Res. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, John Wiley and Sons)

DOI

10.1111/1475-6773.14148

PMID

36829289

Abstract

OBJECTIVE: To compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults DATA SOURCES AND STUDY SETTING: We used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma. STUDY DESIGN: Survival differences were estimated after applying propensity score-based overlap weights. Subgroup analyses were performed for ambulance-transported patients and by external cause. We assessed the roles of pre-hospital care, hospital quality and volume. DATA COLLECTION: Data were obtained from the Centers for Medicare and Medicaid Services PRINCIPAL FINDINGS: Thirty-day mortality was higher overall at level 1 vs. non-trauma centers by 2.2 [95% confidence interval (CI): 1.8, 2.6] percentage points (pp). Thirty-day mortality was higher at level 1 vs. non-trauma centers by 2.3 [95% CI: 1.9, 2.8] pp for falls and 2.3 [95% CI: 0.2, 4.4] pp for motor vehicle crashes. Differences persisted at one year. Level 1 and 2 trauma centers had similar outcomes. Hospital quality and volume did not explain these differences. In the ambulance-transported subgroup, after adjusting for pre-hospital variables, no statistically significant differences remained.

CONCLUSIONS: Trauma centers may not provide longer survival than similarly sized non-trauma hospitals for severely injured older adults. This article is protected by copyright. All rights reserved.

Language: en

Keywords

injuries; older adults; Medicare; Trauma centers; comparative effectiveness