Howard Nelson-Williams1, Lisa Kodadek2, Joseph Canner2, Eric Schneider2, David Efron3, Elliott Haut4, Babar Shafiq5, Adil Haider6, Catherine Garrison Velopulos7. 1. Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland. 2. Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland; Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland. 3. Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland; Division of Acute Care Surgery and Adult Trauma Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland. 4. Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland; Department of Surgery, Anesthesiology / Critical Care Medicine (ACCM), Emergency Medicine, Johns Hopkins University, Baltimore, Maryland; Health Policy & Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. 5. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland. 6. Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts. 7. Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland; Division of Acute Care Surgery and Adult Trauma Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland. Electronic address: cvelopu1@jhmi.edu.
Abstract
BACKGROUND: Younger, multi-trauma patients have improved survival when treated at a trauma center. Many regions now propose that older patients be triaged to a higher level trauma centers (HLTCs-level I or II) versus lower level trauma centers (LLTCs-level III or nondesignated TC), even for isolated injury, despite the absence of an established benefit in this elderly cohort. We therefore sought to determine if older isolated hip fracture patients have improved survival outcomes based on trauma center level. METHODS: A retrospective cohort of 1.07 million patients in The Nationwide Emergency Department Sample from 2006-2010 was used to identify 239,288 isolated hip fracture patients aged ≥65 y. Multivariable logistic regression was performed controlling for patient- and hospital-level variables. The main outcome measures were inhospital mortality and discharge disposition. RESULTS: Unadjusted logistic regression analyses revealed 8% higher odds of mortality (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.00-1.16) and 10% lower odds of being discharged home (OR, 0.90; 95% CI, 0.80-1.00) among patients admitted to an HLTC versus LLTC. After controlling for patient- and hospital-level factors, neither the odds of mortality (OR, 1.06; 95% CI, 0.97-1.15) nor the odds of discharge to home (OR, 0.98; 95% CI, 0.85-1.12) differed significantly between patients treated at an HLTC versus LLTC. CONCLUSIONS: Among patients with isolated hip fractures admitted to HLTCs, mortality and discharge disposition do not differ from similar patients admitted to LLTCs. These findings have important implications for trauma systems and triage protocols.
BACKGROUND: Younger, multi-traumapatients have improved survival when treated at a trauma center. Many regions now propose that older patients be triaged to a higher level trauma centers (HLTCs-level I or II) versus lower level trauma centers (LLTCs-level III or nondesignated TC), even for isolated injury, despite the absence of an established benefit in this elderly cohort. We therefore sought to determine if older isolated hip fracturepatients have improved survival outcomes based on trauma center level. METHODS: A retrospective cohort of 1.07 million patients in The Nationwide Emergency Department Sample from 2006-2010 was used to identify 239,288 isolated hip fracturepatients aged ≥65 y. Multivariable logistic regression was performed controlling for patient- and hospital-level variables. The main outcome measures were inhospital mortality and discharge disposition. RESULTS: Unadjusted logistic regression analyses revealed 8% higher odds of mortality (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.00-1.16) and 10% lower odds of being discharged home (OR, 0.90; 95% CI, 0.80-1.00) among patients admitted to an HLTC versus LLTC. After controlling for patient- and hospital-level factors, neither the odds of mortality (OR, 1.06; 95% CI, 0.97-1.15) nor the odds of discharge to home (OR, 0.98; 95% CI, 0.85-1.12) differed significantly between patients treated at an HLTC versus LLTC. CONCLUSIONS: Among patients with isolated hip fractures admitted to HLTCs, mortality and discharge disposition do not differ from similar patients admitted to LLTCs. These findings have important implications for trauma systems and triage protocols.
Authors: Jordan B Pasternack; Matthew L Ciminero; Michael Silver; Joseph Chang; Piyush Gupta; Kevin K Kang Journal: Geriatr Orthop Surg Rehabil Date: 2020-03-16