Abstract
Purpose of Review
The aging population of the injured has had a profound effect on injury epidemiology.
Recent Findings
A recent analysis demonstrates that outcomes in the geriatric population are improved in centers that treat a higher number of elderly trauma patients.
Summary
To better prevent injuries and manage their population of patients, trauma care providers must concern themselves not only with understanding the overall rates of injury and admissions but also the likelihood that elderly patients will be admitted in greater numbers as well as make up a greater proportion of trauma admissions.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
U.S. Census Bureau. 2014 national population projections summary tables. Table 6: percent distribution of the projected population by sex and selected age groups for the U.S.: 2015 to 2060. Available at www.census.gov/population/projections/data/national/2014/summarytables.html. Accessed 31 Oct 2016.
Kodadek LM, Selvarajah S, Velopulos CG, Haut ER, Haider AH. Undertriage of older trauma patients: is this a national phenomenon? J Surg Res. 2015;199:220–9.
Fildes JJ. National Trauma Data Bank Report 2004. Accessed 16 Oct 2016.
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• Web-based injury statistics query and reporting system, injury center, centers for disease control. https://www.cdc.gov/injury/wisqars/ Accessed 1 Dec 2016. An interactive website of all fatal and nonfatal injuries that reports a large amount of demographic information and can be sorted by age, mechanism of injury, year, and state. Output can be in customizable tables or regional maps. There is not a great level of detail, but it is the most complete population-based injury data available and is extremely easy to access and use.
Injury prevention and control: motor vehicle safety, older adult drivers. http://www.cdc.gov/motorvehiclesafety/older_adult_drivers/ Accessed 1 Dec 2016.
Insurance institute for highway safety: older drivers. http://www.iihs.org/iihs/topics/t/older-drivers/fatalityfacts/older-people Accessed 1 Dec 2016.
• Kozar RA, Arbabi S, Stein DM, et al. Injury in the aged: geriatric trauma care at the crossroads. J Trauma Acute Care Surg. 2015;78:1197–209. A white paper summary that presents data from two surveys administered by the American Association for the Surgery of Trauma’s Geriatric Trauma Committee. The survey addressed the AAST members’ definition of geriatric trauma, epidemiologic knowledge, geriatric trauma resources, clinical interest, and strategies for improving geriatric care. It highlights the gap in knowledge and practice, and the opportunities that exist for improving geriatric care. Several, including fall prevention initiatives, are remarkably uncomplicated and require the implementation of current programs that have been proven effective.
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Top ten causes of injury. http://www.cdc.gov/injury/wisqars/leadingcauses.html. Accessed 1 Dec 2016.
• Cook AC, Joseph B, Inaba K, et al. Multicenter external validation of the geriatric trauma outcome score: a study by the Prognostic Assessment of Life and Limitations after Trauma in the Elderly (PALLIATE) consortium. J Trauma Acute Care Surg. 2016;80:204–9. Validation of the Geriatric Trauma Outcomes score, the first tool that provides specific individual prognostic information for geriatric trauma patients. The tool incorporates age, ISS, and transfusions within the first 24 h using data from 4 level I trauma centers. This model predicts the likelihood of in-hospital mortality with a high degree of accuracy, AUC 0.86. This information can be used to guide prognostic discussions with elderly patients and their families.
• Davidson GH, Hamlat CA, Rivara FP, Koepsell TD, Jurkovich GJ, Arbabi S. Long-term survival of adult trauma patients. JAMA. 2011;305(10):1001–7. A retrospective cohort study of 124,421 injured adult patients during January 1995 to December 2008 using the Washington State Trauma Registry linked to death certificate data. Among adults admitted for trauma in the Washington State, 3-year cumulative mortality was 16% despite a decline in in-hospital deaths. Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality, while discharge to an inpatient rehabilitation facility was not associated with an increased mortality risk.
• Ayoung-Chee P, Rivara FP, Weiser T, Maier RV, Arbabi S. Beyond the hospital doors: improving long-term outcomes for elderly trauma patients. J Trauma Acute Care Surg. 2015;78:837–43. An extremely interesting analysis of the National Trauma Data Bank’s National Sample Project and the Nationwide Inpatient Sample, comparing discharge disposition and outcome of elderly trauma patients to elderly patients suffering a stroke. From the period 2003–2009, the proportion of trauma patients discharged to skilled nursing facilities increased from 31 to 41%, while the proportion discharged to inpatient rehabilitation centers decreased from 26 to 16%. Given the previous data from the same group (Davidson, et al, JAMA 2010 above) demonstrating an increased mortality for elderly trauma patients discharged to a skilled nursing facility, this is a disturbing trend.
Joseph B, Pandit V, Zangbar B, et al. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg. 2014;149:769–72.
Maxwell CA, Mion LC, Mukherjee K, Dietrich MS, Minnick A, May A, et al. Preinjury physical frailty and cognitive impairment among geriatric trauma patients determine postinjury functional recovery and survival. J Trauma Acute Care Surg. 2016;80:195–203.
• Zafar SN, Obirieze A, Schneider EB, et al. Outcomes of trauma care at centers treating a higher proportion of older patients: the case for geriatric trauma centers. J Trauma Acute Care Surg. 2015;78:852–9. An NTDB analysis of level I and level II trauma centers treating 500 patients or more demonstrating an expected higher mortality in elderly patients (odds ratio 4.2, 95% CI 3.99–4.50) an a lower mortality in patients treated at centers with a higher volume of patients >65. Odds ratio for mortality at higher volume centers was 0.66, 95% CI 0.54–0.81. Interestingly and unexpectedly, these centers were more likely to be level II centers (odds ratio 1.15, 95% CI 1.05–1.25).
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Dr. Brasel declares no conflicts of interest relevant to this manuscript.
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This article is part of the Topical Collection on Geriatric Trauma
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Brasel, K. Changing Epidemiology of Injury in the USA. Curr Trauma Rep 3, 1–7 (2017). https://doi.org/10.1007/s40719-017-0073-3
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DOI: https://doi.org/10.1007/s40719-017-0073-3