TY  - JOUR
PY  - 2015//
TI  - Outcomes of trauma care at centers treating a higher proportion of older patients: the case for geriatric trauma centers
JO  - Journal of trauma and acute care surgery
A1  - Zafar, Syed Nabeel
A1  - Obirieze, Augustine
A1  - Schneider, Eric B.
A1  - Hashmi, Zain G.
A1  - Scott, Valerie K.
A1  - Greene, Wendy R.
A1  - Efron, David T.
A1  - MacKenzie, Ellen J.
A1  - Cornwell, Edward E.
A1  - Haider, Adil H.
SP  - 852
EP  - 859
VL  - 78
IS  - 4
N2  - BACKGROUND: The burden of injury among older patients continues to grow and accounts for a disproportionate number of trauma deaths. We wished to determine if older trauma patients have better outcomes at centers that manage a higher proportion of older trauma patients. <br><br>METHODS: The National Trauma Data Bank years 2007 to 2011 was used. All high-volume Level 1 and Level 2 trauma centers were included. Trauma centers were categorized by the proportion of older patients seen. Adult trauma patients were categorized as older (≥65 years) and younger adults (16-64 years). Coarsened exact matching was used to determine differences in mortality and length of stay between older and younger adults. Risk-adjusted mortality ratios by proportion of older trauma patients seen were analyzed using multivariate logistic regression models and observed-expected ratios. <br><br>RESULTS: A total of 1.9 million patients from 295 centers were included. Older patients accounted for one fourth of trauma visits. Matched analysis revealed that older trauma patients were 4.2 times (95% confidence interval, 3.99-4.50) more likely to die than younger patients. Older patients were 34% less likely to die if they presented at centers treating a high versus low proportion of older trauma (odds ratio, 0.66; 95% confidence interval, 0.54-0.81). These differences were independent of trauma center performance. <br><br>CONCLUSION: Geriatric trauma patients treated at centers that manage a higher proportion of older patients have improved outcomes. This evidence supports the potential advantage of treating older trauma patients at centers specializing in geriatric trauma. LEVEL OF EVIDENCE: Prognostic epidemiologic, level III.<p />  <p>Language: en</p>
LA  - en
SN  - 2163-0755
UR  - http://dx.doi.org/10.1097/TA.0000000000000557
ID  - ref1
ER  -