Factors Associated with Trauma Center Use for Elderly Patients with Trauma

A Statewide Analysis, 1999-2008

As the U.S. population ages, more and more elderly will seek care for traumatic injuries. These researchers in California wanted to determine what the likelihood was that elderly trauma patients—compared to younger ones—were admitted to a trauma center for care. They looked at records for 430,081 patients admitted to acute care hospitals (1999–2008) for trauma-related injuries (blunt injury, penetrating injury, falls).

Some 27 percent of the patients were ages 65 years and older. While most nonelderly patients were men (63%), elderly patients tended to be women (65%). The elderly had many more falls as the cause of injury (81.5%) than nonelderly (28%).

After controlling for injury severity, insurance, income, proximity to a trauma center and availability of a county trauma center, patients older than 65 had a “dramatically decreased likelihood of being admitted to a trauma center” compared with younger patients, the researchers write.

Given the limited resources available for trauma care, the researchers consider there might be an under-triaging of care in the elderly resulting in age-biased rationing of care. However, recommendations that patients older than 55 automatically be taken to a trauma center regardless of injury, may result in over-triaging and unnecessary and costly initiations of multidisciplinary team responses.