Craig D Newgard1, Aaron Caughey2, K John McConnell1,3, Amber Lin1, Elizabeth Eckstrom4, Denise Griffiths1, Susan Malveau1, Eileen Bulger5. 1. Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland. 2. Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland. 3. Center for Health Systems Effectiveness, Department of Emergency Medicine, Oregon Health & Science University, Portland. 4. Division of Geriatrics, Department of Internal Medicine, Oregon Health & Science University, Portland. 5. Department of Surgery, University of Washington, Seattle.
Abstract
Importance: Trauma registries are the primary data mechanism in trauma systems to evaluate and improve the care of injured patients. Research has suggested that trauma registries may miss high-risk older adults, who commonly experience morbidity and mortality after injury. Objective: To compare injured older adults who were included in with those excluded from trauma registries, with a focus on patients with serious injuries, requiring major surgery, or dying after injury. Design, Setting, and Participants: This cohort study included all injured adults 65 years and older transported by 44 emergency medical services agencies to 51 trauma and nontrauma centers in 7 counties in Oregon and Washington from January 1, 2011, to December 31, 2011, with follow-up through December 31, 2012. Record linkage was used to match emergency medical services records with state trauma registries, state discharge databases, state death registries, and Medicare claims. Data were analyzed from August to November 2018. Exposures: Inclusion in vs exclusion from a trauma registry. Main Outcomes and Measures: Mortality up to 12 months, including time to death and causes of death. Results: Of 8161 included patients, 5579 (68.4%) were women, and the mean (SE) age was 82.2 (0.10) years. A total of 1720 older adults (21.1%) were matched to a trauma registry record. Seriously injured patients not captured by trauma registries ranged from 18% (7 of 38 patients with abdominal-pelvic Abbreviated Injury Scale score of 3 or greater) to 80.0% (1792 of 2241 patients with extremity Abbreviated Injury Scale score of 3 or greater), while 68 of 186 patients requiring major nonorthopedic surgery (36.6%) and 1809 of 2325 patients requiring orthopedic surgery (77.8%) were not included in trauma registries. Of patients with serious injuries or undergoing major surgery missed by trauma registries (range by injury and procedure type, 36.0% to 57.1%), 36.4% (39.3% when excluding serious extremity injuries and orthopedic procedures) were treated at trauma centers, particularly level III through V hospitals. When registry and nonregistry groups were tracked over 12 months, 93 of 188 in-hospital deaths (49.5%) and 1531 of 1887 total deaths (81.1%) occurred in the nonregistry cohort. Conclusions and Relevance: In their current form, trauma registries are ineffective in capturing, tracking, and evaluating injured older adults, although mortality following injury is frequently due to noninjury causes. High-risk injured older adults are not included in registries because of care in nontrauma hospitals, restrictive registry inclusion criteria, and being missed by registries in trauma centers.
Importance: Trauma registries are the primary data mechanism in trauma systems to evaluate and improve the care of injured patients. Research has suggested that trauma registries may miss high-risk older adults, who commonly experience morbidity and mortality after injury. Objective: To compare injured older adults who were included in with those excluded from trauma registries, with a focus on patients with serious injuries, requiring major surgery, or dying after injury. Design, Setting, and Participants: This cohort study included all injured adults 65 years and older transported by 44 emergency medical services agencies to 51 trauma and nontrauma centers in 7 counties in Oregon and Washington from January 1, 2011, to December 31, 2011, with follow-up through December 31, 2012. Record linkage was used to match emergency medical services records with state trauma registries, state discharge databases, state death registries, and Medicare claims. Data were analyzed from August to November 2018. Exposures: Inclusion in vs exclusion from a trauma registry. Main Outcomes and Measures: Mortality up to 12 months, including time to death and causes of death. Results: Of 8161 included patients, 5579 (68.4%) were women, and the mean (SE) age was 82.2 (0.10) years. A total of 1720 older adults (21.1%) were matched to a trauma registry record. Seriously injured patients not captured by trauma registries ranged from 18% (7 of 38 patients with abdominal-pelvic Abbreviated Injury Scale score of 3 or greater) to 80.0% (1792 of 2241 patients with extremity Abbreviated Injury Scale score of 3 or greater), while 68 of 186 patients requiring major nonorthopedic surgery (36.6%) and 1809 of 2325 patients requiring orthopedic surgery (77.8%) were not included in trauma registries. Of patients with serious injuries or undergoing major surgery missed by trauma registries (range by injury and procedure type, 36.0% to 57.1%), 36.4% (39.3% when excluding serious extremity injuries and orthopedic procedures) were treated at trauma centers, particularly level III through V hospitals. When registry and nonregistry groups were tracked over 12 months, 93 of 188 in-hospital deaths (49.5%) and 1531 of 1887 total deaths (81.1%) occurred in the nonregistry cohort. Conclusions and Relevance: In their current form, trauma registries are ineffective in capturing, tracking, and evaluating injured older adults, although mortality following injury is frequently due to noninjury causes. High-risk injured older adults are not included in registries because of care in nontrauma hospitals, restrictive registry inclusion criteria, and being missed by registries in trauma centers.
Authors: Craig D Newgard; Rongwei Fu; Dana Zive; Tom Rea; Susan Malveau; Mohamud Daya; Jonathan Jui; Denise E Griffiths; Lynn Wittwer; Ritu Sahni; K Dean Gubler; Jonathan Chin; Pat Klotz; Stephanie Somerville; Tina Beeler; T J Bishop; Tara N Garland; Eileen Bulger Journal: J Am Coll Surg Date: 2015-11-14 Impact factor: 6.113
Authors: Craig D Newgard; Rongwei Fu; E Brooke Lerner; Mohamud Daya; Dagan Wright; Jonathan Jui; N Clay Mann; Eileen Bulger; Jerris Hedges; Lynn Wittwer; David Lehrfeld; Thomas Rea Journal: J Trauma Acute Care Surg Date: 2017-09 Impact factor: 3.313
Authors: Ross J Fleischman; N Clay Mann; Mengtao Dai; James F Holmes; N Ewen Wang; Jason Haukoos; Renee Y Hsia; Thomas Rea; Craig D Newgard Journal: J Trauma Nurs Date: 2017 Jan/Feb Impact factor: 1.010
Authors: Joseph S Farhat; Vic Velanovich; Anthony J Falvo; H Mathilda Horst; Andrew Swartz; Joe H Patton; Ilan S Rubinfeld Journal: J Trauma Acute Care Surg Date: 2012-06 Impact factor: 3.313
Authors: Carlos D Marquez de la Plata; Tessa Hart; Flora M Hammond; Alan B Frol; Anne Hudak; Caryn R Harper; Therese M O'Neil-Pirozzi; John Whyte; Mary Carlile; Ramon Diaz-Arrastia Journal: Arch Phys Med Rehabil Date: 2008-05 Impact factor: 3.966
Authors: James Forrest Calland; Angela M Ingraham; Niels Martin; Gary T Marshall; Carl I Schulman; Tristan Stapleton; Robert D Barraco Journal: J Trauma Acute Care Surg Date: 2012-11 Impact factor: 3.313
Authors: Timothy F Platts-Mills; Robert J Nicholson; Natalie L Richmond; Kushang V Patel; Eleanor M Simonsick; Robert M Domeier; Robert A Swor; Phyllis L Hendry; David A Peak; Niels K Rathlev; Jeffrey S Jones; David C Lee; Mark A Weaver; Francis J Keefe; Samuel A McLean Journal: BMC Geriatr Date: 2016-04-19 Impact factor: 3.921
Authors: Johannes Gleich; Evi Fleischhacker; Katherine Rascher; Thomas Friess; Christian Kammerlander; Wolfgang Böcker; Benjamin Bücking; Ulrich Liener; Michael Drey; Christine Höfer; Carl Neuerburg Journal: J Clin Med Date: 2021-11-23 Impact factor: 4.241
Authors: Molly P Jarman; Ginger Jin; Joel S Weissman; Arlene S Ash; Jennifer Tjia; Ali Salim; Adil Haider; Zara Cooper Journal: JAMA Netw Open Date: 2022-03-01
Authors: Elinore J Kaufman; Alexis M Zebrowski; Daniel N Holena; Phillipe Loher; Douglas J Wiebe; Brendan G Carr Journal: J Surg Res Date: 2021-07-16 Impact factor: 2.192
Authors: Vanessa P Ho; Sasha D Adams; Kathleen M O'Connell; Christine S Cocanour; Saman Arbabi; Elisabeth B Powelson; Zara Cooper; Deborah M Stein Journal: Trauma Surg Acute Care Open Date: 2021-07-15