Increased Trauma Activation Is Not Equally Beneficial For All Elderly Trauma Patients

dc.contributor.authorCarr, Bryan W.
dc.contributor.authorHammer, Peter M.
dc.contributor.authorTimsina, Lava
dc.contributor.authorRozycki, Grace
dc.contributor.authorFeliciano, David V.
dc.contributor.authorColeman, Jamie J.
dc.contributor.departmentSurgery, School of Medicineen_US
dc.date.accessioned2018-06-08T19:39:51Z
dc.date.available2018-06-08T19:39:51Z
dc.date.issued2018-05
dc.description.abstractBackground Physiologic changes in the elderly lead to higher morbidity and mortality after injury. Increasing level of trauma activation has been proposed to improve geriatric outcomes; but, the increased cost to the patient and stress to the hospital system are significant downsides. The purpose of this study was to identify the age at which an increase in activation status is beneficial. Methods A retrospective review of trauma patients ≥ 70 years old from October 1, 2011, to October 1, 2016 was performed. On October 1, 2013, a policy change increased the activation criteria to the highest level for patients ≥ 70 years of age with a significant mechanism of injury. Patients who presented prior to (PRE) were compared to those after the change (POST). Data collected included age, injury severity score (ISS), length of stay (LOS), complications and mortality. Primary outcome was mortality and secondary outcome was LOS. Multivariable regressions controlled for age, ISS, injury mechanism, and number of complications. Results 4341 patients met inclusion criteria, 1919 in PRE and 2422 in POST. Mean age was 80.4 and 81 years in PRE and POST groups respectively (p=0.0155). Mean ISS values were 11.6 and 12.4 (p<0.0001) for the PRE and POST groups. POST had more level 1 activations (696 vs. 220, p<0.0001). After controlling for age, ISS, mechanism of injury, and number of complications, mortality was significantly reduced in the POST group ≥ age 77 years (OR 0.53, 95% CI: 0.3 - 0.87), (Figure 1). Hospital LOS was significantly reduced in the POST group ≥ age 78 (regression coefficient -0.55, 95% CI: -1.09, -0.01) (Figure 2). Conclusions This study suggests geriatric trauma patients ≥ 77 years benefit from the highest level of trauma activation with shorter LOS and lower mortality. A focused approach to increasing activation level for elderly patients may decrease patient cost. Level of Evidence Level III Type of Study Economic/Decisionen_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationCarr, B. W., Hammer, P. M., Timsina, L., Rozycki, G., Feliciano, D. V., & Coleman, J. J. (2018). Increased Trauma Activation Is Not Equally Beneficial For All Elderly Trauma Patients. Journal of Trauma and Acute Care Surgery, Publish Ahead of Print. https://doi.org/10.1097/TA.0000000000001986en_US
dc.identifier.urihttps://hdl.handle.net/1805/16448
dc.language.isoenen_US
dc.publisherWolters Kluweren_US
dc.relation.isversionof10.1097/TA.0000000000001986en_US
dc.relation.journalJournal of Trauma and Acute Care Surgeryen_US
dc.rightsPublisher Policyen_US
dc.sourceAuthoren_US
dc.subjectgeriatric traumaen_US
dc.subjecttrauma activation criteriaen_US
dc.subjecttriageen_US
dc.titleIncreased Trauma Activation Is Not Equally Beneficial For All Elderly Trauma Patientsen_US
dc.typeArticleen_US
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