Evaluating the outcomes of blunt thoracic trauma in elderly patients following a fall from a ground level: higher level care institution vs. lower level care institution
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The purpose of the study is to evaluate the outcomes of higher level care institutions of elderly patients who sustained a thoracic injury after a ground-level fall (GLF).
Higher level care institutions have a better survival.
The National Trauma Data Bank (NTDB) data set of 2012–2014 was accessed for the study. All patients, 65 years of age and older, who experienced a GLF and sustained a thoracic injury, were included in the study. Patient demography, injury characteristics including injury severity score (ISS), Glasgow coma scale (GCS) motor score, comorbidities, and patient outcomes were compared between the higher level care institution [American College of Surgeon (ACS) level I and level II trauma centers) and lower level care institution (ACS level III and level IV and unranked-trauma centers). On univariate analysis, some significant patient characteristic differences were found; therefore, propensity score matching and paired analyses were performed. All P values are two sided, and a P value < 0.05 was considered statistically significant.
Out of the 15,256 patients who satisfied the inclusion criteria, approximately 52% (7994) of patients were treated at a higher level care institution. On univariate analysis, significant differences were found between the lower level care institution and higher level care institution regarding male gender (44.2% vs.46%, P = 0.03), ISS median [interquartile] (9 [5–12] vs. 9 [5–13], P < 0.001), history of alcohol abuse (4.2% vs. 5.3%, P = 0.007), dementia (8.7% vs. 9.8%, P = 0.02), bleeding disorder or history of anticoagulation use (17% vs. 18.4%, P = 0.03), obesity (5% vs. 6.6%, P < 0.001), and abbreviated injury scale (AIS) thorax (2 [1–3] vs. 3 [2–3], P < 0.001). After propensity score matching, the majority of the characteristics were balanced with few exceptions, including ISS, AIS ≥ 3 head and abdomen, and P values < 0.05. The overall in-hospital mortality was not significantly different between the higher level care institution vs. the lower level care institution (4.4% vs. 3.9%, P = 0.14). The median hospital length of stay and 95% confidence interval between both groups was (5 [5, 5] and 5 [5, 5], P = 0.72).
Treating elderly patients with blunt chest trauma in higher level care institutions failed to show any benefit in overall survival or hospital length of stay.
Level of evidence
KeywordsElderly Fall Chest trauma Higher level care institution Mortality
Nasim Ahmed designed the study, accessed the data, and contributed to the manuscript. Yen-Hong Kuo performed the statistical analyses and contributed in the creation of manuscript. Nasim Ahmed was also responsible for overall integrity of the study. Don Winters performed the critical reading and final editing of the manuscript. Nasim Ahmed and Yen-Hong Kuo declare no conflict of interest.
NA conceived and designed the study. NA was responsible for retrieving the study data, while Y-HK performed the data analysis. NA and Y-HK both contributed to manuscript writing and both were responsible for all follow-up manuscript revisions.
There was no funding provided for this study.
Compliance with ethical standards
Conflict of interest
Neither of the contributing authors have a conflict of interest to disclose, financial or otherwise.
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