Outcomes of care at higher-level trauma centers in octogenarians with a history of anticoagulant use who fall from ground level

TY - JOUR

T1 - Outcomes of care at higher-level trauma centers in octogenarians with a history of anticoagulant use who fall from ground level

AU - Ahmed, Nasim

AU - Kuo, Yen Hong

N1 - Publisher Copyright: © 2023 Elsevier Ltd

PY - 2023/9

Y1 - 2023/9

N2 - Background: The appropriate care of octogenarian trauma patients after a fall from ground level (FFGL) is a key factor for better outcomes. The purpose of this study is to use data from a national database to evaluate the outcomes of patients who are 80–89 years old with a history of anticoagulant use, sustained a FFGL, and were treated at a higher-level care institution. Methods: The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017–2018 was accessed for the study. All hospitalized trauma patients between the ages of 80–89 years old with a history of anticoagulant use and sustaining an injury after FFGL were included in the study. Other variables included in the study are sex [male], race [white], initial systolic blood pressure (SBP mmHg), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hypotension with an SBP<110 mmHg and other comorbidities. The outcomes of the patients were compared with the care at higher-level trauma centers (Level I & Level II) and lower-level trauma centers (Level III) using propensity matched analysis. Results: After propensity matching, 2348 patients were identified in each group. There was no clinically significant difference between the patients’ characteristics who were treated at higher-level and lower-level care centers. A paired matched analysis showed greater mortality in patients who were treated at higher-level care centers compared to lower-level care centers (3.7% vs 2.6%, P = 0.03). The absolute difference in mortality was 1.1%[95% CI: 0.001, 0.022] which may not have any clinical relevance. A greater number of patients were discharged to home and a lesser number of patients were discharged to a skilled nursing facility (SNF) when they were treated at higher-level trauma centers. Conclusion & relevance: The care at higher-level trauma centers did not show any benefit in-hospital mortality in the short term. A higher number of patients was discharged to home without assistance.

AB - Background: The appropriate care of octogenarian trauma patients after a fall from ground level (FFGL) is a key factor for better outcomes. The purpose of this study is to use data from a national database to evaluate the outcomes of patients who are 80–89 years old with a history of anticoagulant use, sustained a FFGL, and were treated at a higher-level care institution. Methods: The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017–2018 was accessed for the study. All hospitalized trauma patients between the ages of 80–89 years old with a history of anticoagulant use and sustaining an injury after FFGL were included in the study. Other variables included in the study are sex [male], race [white], initial systolic blood pressure (SBP mmHg), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hypotension with an SBP<110 mmHg and other comorbidities. The outcomes of the patients were compared with the care at higher-level trauma centers (Level I & Level II) and lower-level trauma centers (Level III) using propensity matched analysis. Results: After propensity matching, 2348 patients were identified in each group. There was no clinically significant difference between the patients’ characteristics who were treated at higher-level and lower-level care centers. A paired matched analysis showed greater mortality in patients who were treated at higher-level care centers compared to lower-level care centers (3.7% vs 2.6%, P = 0.03). The absolute difference in mortality was 1.1%[95% CI: 0.001, 0.022] which may not have any clinical relevance. A greater number of patients were discharged to home and a lesser number of patients were discharged to a skilled nursing facility (SNF) when they were treated at higher-level trauma centers. Conclusion & relevance: The care at higher-level trauma centers did not show any benefit in-hospital mortality in the short term. A higher number of patients was discharged to home without assistance.

KW - Fall from a ground level

KW - Higher level care

KW - Octogenarians

KW - Outcomes

UR - https://www.scopus.com/pages/publications/85153932579

U2 - 10.1016/j.injury.2023.04.005

DO - 10.1016/j.injury.2023.04.005

M3 - Article

C2 - 37127447

SN - 0020-1383

VL - 54

JO - Injury Extra

JF - Injury Extra

IS - 9

M1 - 110718

ER -