Comparison of Injured Older Adults Included in vs Excluded From Trauma Registries With 1-Year Follow-up
Comparison of Injured Older Adults Included in vs Excluded From Trauma Registries With 1-Year Follow-up
复制标题
DOI：
10.1001/jamasurg.2019.2279
复制
发表时间：
2019-09-01
期刊：
影响因子：
16.9
通讯作者：
Bulger, Eileen
中科院分区：
文献类型：
--
作者：
Newgard, Craig D.;Caughey, Aaron;Bulger, Eileen
关键点问题创伤登记处在捕获、跟踪和评估受伤的老年人方面是否有效？在这项队列研究中，44家急救医疗服务机构将8161名65岁及以上的受伤成年人运送到俄勒冈州和华盛顿州的51家医院，创伤登记漏掉了188名住院死亡患者中的93名(49.5%)，553名严重受伤患者中的178名(32.2%)，以及186名需要进行大型非骨科手术的患者中的68名(36.6%)。当对登记和未登记的队列进行超过1年的跟踪时，1887例受伤后死亡中有1531例(81.1%)发生在未登记组。这意味着创伤登记对于研究受伤的老年人来说是无效的数据源，包括那些严重受伤、需要进行大手术或受伤后死亡的人。这项队列研究评估了指数事件发生后1年内受伤老年人的患者特征、受伤模式、手术干预、死亡率和死亡原因，并与那些被排除在创伤登记之外的人进行了比较。重要信息创伤登记是创伤系统中评估和改善受伤患者护理的主要数据机制。研究表明，创伤登记可能会漏掉高危老年人，他们通常会在受伤后经历发病率和死亡率。目的比较纳入创伤登记和排除在创伤登记之外的受伤老年人，重点是严重创伤、需要大手术或受伤后死亡的患者。设计、设置和参与者这项队列研究包括从2011年1月1日到2011年12月31日期间，由44家紧急医疗服务机构运送到俄勒冈州和华盛顿州7个县的51个创伤和非创伤中心的所有65岁及65岁以上的受伤成年人，并进行跟踪调查，直至2012年12月31日。记录链接用于将紧急医疗服务记录与州创伤登记处、州出院数据库、州死亡登记处和医疗保险索赔进行匹配。对2018年8月至11月的数据进行了分析。暴露VS排除在创伤登记中。主要结果和测量12个月以下的死亡率，包括死亡时间和死亡原因。结果8161例患者中，女性5579例(68.4%)，平均年龄82.2岁(0.10岁)。共有1720名老年人(21.1%)与创伤登记记录相匹配。未被纳入创伤登记的重伤患者从18%(腹盆缩略伤评分为3分或以上的38名患者中的7名)到80.0%(肢体短伤评分3分或以上的2241名患者中的1792名)，而186名需要进行重大非骨科手术的患者中有68名(36.6%)和2325名需要骨科手术的患者中的1809名(77.8%)未被纳入创伤登记。在创伤登记处漏掉的严重损伤或大手术患者中(按创伤和手术类型划分，36.0%至57.1%)，36.4%(剔除严重肢体损伤和骨科手术后39.3%)在创伤中心接受治疗，特别是三级至五级医院。当对登记组和非登记组进行超过12个月的跟踪时，188例住院死亡中的93例(49.5%)和1887例总死亡中的1531例(81.1%)发生在非登记组队列中。结论和关系在目前的形式下，创伤登记在捕获、跟踪和评估受伤的老年人方面是无效的，尽管受伤后的死亡通常是由非损伤原因造成的。高危受伤的老年人不包括在登记中，因为非创伤医院的护理，登记纳入标准的限制性，以及创伤中心登记的遗漏。
Key PointsQuestionAre trauma registries effective in capturing, tracking, and evaluating injured older adults? FindingsIn this cohort study of 8161 injured adults 65 and older transported by 44 emergency medical services agencies to 51 hospitals in Oregon and Washington, trauma registries missed 93 of 188 in-hospital deaths (49.5%), 178 of 553 patients with serious injuries (32.2%), and 68 of 186 patients requiring major nonorthopedic surgery (36.6%). When registry and nonregistry cohorts were tracked over 1 year, 1531 of 1887 deaths after injury (81.1%) occurred in the nonregistry group. MeaningTrauma registries are ineffective data sources for studying injured older adults, including those with serious injuries, requiring major surgery, or dying after injury.This cohort study evaluates patient characteristics, injury patterns, surgical interventions, mortality, and causes of death up to 1 year after the index event among injured older adults who were included in compared with those who were excluded from trauma registries.ImportanceTrauma registries are the primary data mechanism in trauma systems to evaluate and improve the care of injured patients. Research has suggested that trauma registries may miss high-risk older adults, who commonly experience morbidity and mortality after injury. ObjectiveTo compare injured older adults who were included in with those excluded from trauma registries, with a focus on patients with serious injuries, requiring major surgery, or dying after injury. Design, Setting, and ParticipantsThis cohort study included all injured adults 65 years and older transported by 44 emergency medical services agencies to 51 trauma and nontrauma centers in 7 counties in Oregon and Washington from January 1, 2011, to December 31, 2011, with follow-up through December 31, 2012. Record linkage was used to match emergency medical services records with state trauma registries, state discharge databases, state death registries, and Medicare claims. Data were analyzed from August to November 2018. ExposuresInclusion in vs exclusion from a trauma registry. Main Outcomes and MeasuresMortality up to 12 months, including time to death and causes of death. ResultsOf 8161 included patients, 5579 (68.4%) were women, and the mean (SE) age was 82.2 (0.10) years. A total of 1720 older adults (21.1%) were matched to a trauma registry record. Seriously injured patients not captured by trauma registries ranged from 18% (7 of 38 patients with abdominal-pelvic Abbreviated Injury Scale score of 3 or greater) to 80.0% (1792 of 2241 patients with extremity Abbreviated Injury Scale score of 3 or greater), while 68 of 186 patients requiring major nonorthopedic surgery (36.6%) and 1809 of 2325 patients requiring orthopedic surgery (77.8%) were not included in trauma registries. Of patients with serious injuries or undergoing major surgery missed by trauma registries (range by injury and procedure type, 36.0% to 57.1%), 36.4% (39.3% when excluding serious extremity injuries and orthopedic procedures) were treated at trauma centers, particularly level III through V hospitals. When registry and nonregistry groups were tracked over 12 months, 93 of 188 in-hospital deaths (49.5%) and 1531 of 1887 total deaths (81.1%) occurred in the nonregistry cohort. Conclusions and RelevanceIn their current form, trauma registries are ineffective in capturing, tracking, and evaluating injured older adults, although mortality following injury is frequently due to noninjury causes. High-risk injured older adults are not included in registries because of care in nontrauma hospitals, restrictive registry inclusion criteria, and being missed by registries in trauma centers.