Injured older adults are not taken to trauma centers even when their injuries are severe enough to warrant being seen in such facilities, according to a Stanford University research team led by a trauma surgeon. The findings have implications for long-term care, says Kristan L. Staudenmayer, MD, because elderly patients often die after leaving the hospital, not while in it.
Many elderly people with traumatic injuries—for instance, from unintentional falls—end up in facilities without specialized equipment and around-the-clock expertise in trauma care, the researchers found after examining emergency medical services data from more than 6,000 patients aged at least 55 years who were admitted to hospitals in California and Utah. They also looked at information from state hospital discharge reports, patient records, emergency department records, trauma centers and registries, and death certificates.
“We’re not sure why this is happening, but there is clearly a bias,” says Staudenmayer, the study’s lead author. Without considering underlying health conditions, she adds, triage teams and first responders may underestimate how badly injured elderly patients are.
The 60-day mortality rate was 5.7 percent for those taken to trauma centers and 9 percent for those taken elsewhere. The median hospital stay was one day less for those at trauma centers, and those cared for at trauma centers underwent more interventions and major surgeries, and their care cost more than $20,000 more than care for those not at trauma centers.
“If we’re not doing something right, this will continue to cost lives and dollars,” Staudenmayer says. “When we’re able to identify which patients actually benefit from trauma care, we’ll see fewer deaths in that subgroup. If we see elderly patients who have been on a steady physical decline, we can tell if the fall is a marker of poor outcomes or the cause. Then, we can save lives for some people or at least have a better discussion about how to proceed going forward.”
The study is published in the October issue of the Journal of the American College of Surgeons. Staudenmayer says the next step for researchers is to compare elderly patients’ health statuses before they sustain injuries with outcomes for patients who don’t receive care at trauma centers.
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