The aging of America: a comprehensive look at over 25,000 geriatric trauma admissions to United States hospitals

Abstract

A 2001 study on geriatric trauma by trauma center (TC) status was based on 1989 Medicare data. The purpose of this study was to compare 1989 findings with a 2009 sample, and to examine patient characteristics and outcomes by TC status. From 2009 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS) data, we examined a geographically representative sample (n = 25,512) of injured older adults (>/= age 65) admitted to 127 TCs and non-TCs in 24 states. Data analysis included descriptive statistics for eight patient characteristics and four outcome variables (mortality, discharge disposition, length of stay, and total charges). χ(2) tests were conducted to examine differences between 1989 and 2009 for age groups, gender, and mortality. Higher percentages of patients were in older age groups in 2009, however mortality declined overall (4.8% vs 3.4%, P < .001). Consistent incremental patterns of differences were observed among TC levels for all patient characteristics and outcomes. Level I TCs admitted highest percentages of: lower age groups, males, nonwhite race, motor-vehicle related trauma, and intracranial injuries. Non-TCs admitted highest percentages of oldest age groups, comorbidities, falls, femur neck fractures, and patients requiring OR procedures. Although Level I TCs had higher lengths of stay and total charges, a higher percentage of patients were discharged home. Despite a growing number of patients in older age groups, inpatient mortality declined over two decades. Level I TCs are managing patients at highest risk for decompensation and mortality; a significant percentage of patients are going to non-TCs.