Factors Associated With Trauma Center Use for Elderly Patients With Trauma

Hsia, Renee Y.

doi:10.1001/archsurg.2010.311

Cited by 70 publications

(62 citation statements)

References 60 publications

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“…However, injury severity and patient complexity was similar. Consistent with other studies, 18,38,43, 45 we found that these additional factors were indicative of the location of initial treatment as well as the likelihood of subsequent transfer. compared with children and adults younger than 55 years.…”

Section: Discussionsupporting

confidence: 91%

“…[9][10][11] This confluence of factors has resulted in identified patterns of undertriage associated with poorer outcomes 9,12-15 such as higher rates of trauma-related morbidity and mortality among older patients. [16][17][18] Possible causes for these age-related triage disparities include patient-level variables such as payer status, 19 differences in initial presentation, 2,19,20 location of injury, 21 type of injury, 22 and geographic distance from the nearest emergency department (ED). 23,24 In 1986, the American College of Surgeons (ACS) published the first Field Decision Scheme, which was updated in 1990, 1993, and 1999.…”

Section: Discussionmentioning

confidence: 99%

“…25 Studies of triage patterns during the years following that revision suggest that the age-based criterion introduced in 2006 was inadequate 12,18,25 and that additional age-based criteria would improve field triage of patients aged 70 years and older. 9 There have been few evaluations of the 2011 revision.…”

Section: Discussionmentioning

confidence: 99%

“…The results of this study build on prior work in several important ways. First, several previous studies that identified age-based disparities in trauma care used databases that were limited to individual states 15,18,19,34,37 or hospital types. 38 This study is one of the first 22,25,38 to use a pooled sample of hospitals from 31 states, which provides insight into larger trends.…”

Section: Discussionmentioning

confidence: 99%

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Age‐related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

Flottemesch

Raetzman

Heslin

et al. 2017

Academic Emergency Medicine

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ObjectiveIn 2006, the American College of Surgeons’ Committee on Trauma and the Centers for Disease Control and Prevention released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age‐based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions.MethodsA pre‐post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases with multivariable logistic regressions considered changes in 1) the trauma designation of the emergency department where treatment was initiated and 2) transfer to a TC following initial treatment at a non‐TC.ResultsCompared with adults aged 18 to 44 years, after multivariable adjustment, in both years TC care was less likely for adults aged 45 to 64 years (odds ratio [OR] = 0.76 in 2009 and 0.74 in 2012), aged 65 to 84 years (OR = 0.61 and 0.59), and aged 85+ years (OR = 0.53 and 0.56). Between 2009 and 2012, the likelihood of TC care increased for all age groups, with the largest increase among those aged 85+ years (OR = 1.18), which was statistically different (p = 0.02) from the increase among adults aged 18 to 44 years (OR = 1.12). The analysis of transfers yielded similar results.ConclusionsAlthough patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age‐based disparities persisted.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Age‐related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

Flottemesch

Raetzman

Heslin

et al. 2017

Academic Emergency Medicine

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“…Males significantly more likely to be transported 131 or admitted 132 to a trauma center than females. Male trauma patients more often given priority 1, transported straight to trauma center, and allocated highest level of prehospital competence than females.…”

mentioning

confidence: 99%

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

2017

Critical Care Nurse

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Using written vignettes of homicides that differed only in sex of perpetrator, forensic psychiatrists and students diagnosed the defendant as legally insane significantly more often when perpetrator was a woman. 11World Health Organization 12 and US 13 research found most behavioral disorders (depression, anxiety) are diagnosed twice as often in women.Men receive more intensive treatments than women for common conditions. 14 85% of men vs 55% of women receive oral antihyperglycemics. 15 Despite the UK NICE guideline 27 13,16 (mandates "urgent referral to an oncologist" for painless macroscopic hematuria), 27% of women vs 10% of men had multiple consults before referral. Bladder cancer 5-year survival rate is 57% for men, 44% for women. 17,18 Female gender is independent risk factor for delayed referral and diagnosis of bladder and renal cancer. 19 TKA referral in patients with comparable osteoarthritis severity: physicians deny sex influences referral, but referral rate for men is 3 times that for women. Using identical standardized patients, 42% of physicians recommended TKA for the male, but not the female. Odds of primary care physicians recommending TKA for men was twice that for women; for orthopedic physicians, odds for men was 22 times that for women. 20Patients with osteoarthritis needing hip replacement, women less likely than men to receive 4 of 5 care stages: consult with general practitioner, specialist referral, orthopedic consult, wait listed. 21 Women have more disability before referral. 22Women have lower probability of referral to waiting list for kidney transplantation and longer delay between dialysis and waiting list compared to men. 23-25Women had significantly lower liver transplantation rates than men from 1997 to 2007 and greater deficit to men since. 26Women had pain years longer than men before referral to pain clinic, where women are prescribed minor tranquilizers, sedatives, or antidepressants vs analgesics and opioids for men. 27After abdominal surgery, physicians prescribed less pain medication for women compared to men; nurses gave less pain medication to women. 28After CABG, men received narcotics, women given sedatives. 29First report on gender attributes of pain: physicians minimized women's pain by attributing it to emotional causes. 30 80 physicians (44 men) and 113 nurses (103 women) more likely to treat male patients with opioids than females. Disparity greater for nurses than physicians. 31Despite ACC/AHA PAD guidelines, at discharge, women are significantly less likely than men to be prescribed 3 recommended therapies: statins, aspirin, and β-blockers. 32,33Women are offered surgical revascularization less often (36.4%) than men (53.8%) and are offered CEA less often at all ages. 34 When CEA is offered to women, it is often on a very delayed basis. Delays persist after adjusting for age, history, preoperative TIA, ABCD2 score, degree of stenosis, unilateral symptoms, and symptomatic stenosis. 34 Findings most concerning because female gender is a known, negative, independ...

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Risk of Dementia Diagnosis After Injurious Falls in Older Adults

Ordoobadi,

Dhanani,

Tulebaev

et al. 2024

JAMA Netw Open

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ImportanceEmerging evidence suggests that mild cognitive impairment, which is a precursor to Alzheimer disease and related dementias (ADRD), places older adults at increased risk for falls. However, the risk that an older adult develops dementia after experiencing a fall is unknown.ObjectiveTo determine the risk of new ADRD diagnosis after a fall in older adults.Design, Setting, and ParticipantsThis retrospective cohort study examined Medicare Fee-for-Service data from 2014 to 2015, with follow-up data available for at least 1 year after the index encounter. Participants included adults aged 66 years and older who experienced a traumatic injury that resulted in an emergency department (ED) or inpatient encounter and did not have a preexisting diagnosis of dementia. Data analysis was performed from August 2023 to July 2024.ExposuresExperiencing a fall compared with other mechanisms of injury, defined by International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 external cause of injury codes.Main Outcomes and MeasuresThe hazard of new ADRD diagnosis within 1 year of a fall, assessed by performing a Cox multivariable competing risk model that controlled for potential confounders while accounting for the competing risk of death.ResultsThe study included 2 453 655 older adult patients who experienced a traumatic injury; 1 522 656 (62.1%) were female; 124 396 (5.1%) were Black and 2 232 102 (91.0%) were White; and the mean (SD) age was 78.1 (8.1) years. The mechanism of injury was a fall in 1 228 847 incidents (50.1%). ADRD was more frequently diagnosed within 1 year of a fall compared with other injury mechanisms (10.6% [129 910 of 1 228 847] vs 6.1% [74 799 of 1 224 808]; P &lt; .001). The unadjusted hazard ratio (HR) of incident dementia diagnosis after a fall was 1.63 (95% CI, 1.61-1.64; P &lt; .001). On multivariable Cox competing risk analysis, falling was independently associated with an increased risk of dementia diagnosis among older adults (HR, 1.21 [95% CI, 1.20-1.21]; P &lt; .001) after controlling for patient demographics, medical comorbidities, and injury characteristics, while accounting for the competing risk of death. Among the subset of older adults without a recent skilled nursing facility admission, the HR was 1.27 (95% CI, 1.26-1.28; P &lt; .001).Conclusions and RelevanceIn this cohort study, new ADRD diagnoses were more common after falls compared with other mechanisms of injury, with 10.6% of older adults being diagnosed with ADRD in the first year after a fall. To improve the early identification of ADRD, this study’s findings suggest support for the implementation of cognitive screening in older adults who experience an injurious fall that results in an ED visit or hospital admission.

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Factors Associated With Trauma Center Use for Elderly Patients With Trauma

Cited by 70 publications

References 60 publications

Age‐related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

Age‐related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

Risk of Dementia Diagnosis After Injurious Falls in Older Adults

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