Association of Trauma Center Designation With Postdischarge Survival Among Older Adults With Injuries.
Association of Trauma Center Designation With Postdischarge Survival Among Older Adults With Injuries.
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DOI：
10.1001/jamanetworkopen.2022.2448
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发表时间：
2022-03-01
影响因子：
13.8
通讯作者：
Cooper Z
中科院分区：
文献类型：
--
作者：
Jarman MP;Jin G;Weissman JS;Ash AS;Tjia J;Salim A;Haider A;Cooper Z
受伤老年人的长期死亡率与治疗医院的创伤中心水平有关吗？在这项以人群为基础的队列研究中，433169名受伤的老年医疗保险受益人的长期死亡率没有因创伤中心的状态而变化。这些发现表明，老年人不能像年轻人那样从现有的创伤中心护理中获益，这表明需要修订创伤护理指南和临床实践，以满足受伤老年人的需求。本队列研究评估老年人损伤死亡率与治疗医院创伤中心水平之间的关系。创伤中心改善了严重受伤的年轻患者的预后。然而，大多数与伤害相关的住院和死亡发生在老年人中，尚不清楚创伤中心护理是否能在这一人群中提供同样的益处。研究受伤老年人的30天和365天死亡率是否与治疗医院的创伤中心水平有关。这项前瞻性、基于人群的队列研究使用了2013年1月1日至2016年12月31日的医疗保险索赔数据，涵盖了2014年至2015年因创伤性损伤住院的所有66岁或以上的医疗保险付费服务受益人。数据分析时间为2021年1月1日至6月31日。受伤前的健康状况是用2013年的索赔来衡量的，结果是到2016年衡量的。根据解剖损伤模式对人群进行分层。使用简略损伤量表、年龄和离创伤中心的居住距离来估计I级创伤中心治疗的倾向得分，然后根据损伤类型来匹配每个创伤级别（I、II、III和IV/非创伤中心）的受益人。收治医院的创伤中心级别损伤后30天和365天的病死率（CFRs），在匹配样本中使用多变量、分层逻辑回归模型估计。分析共纳入433 169名Medicare受益人（平均[SD]年龄82.9[8.3]岁，女性68.4%，白人91.5%）。206 275人（47.6%）入住非创伤中心，161 492人（37.3%）入住一、二级创伤中心。孤立性四肢骨折患者的死亡率最低（365天CFR范围为16.1% [95% CI, 11.2%-22.4%]至17.4% [95% CI, 11.8%-24.6%]）。髋部骨折和外伤性脑损伤患者的死亡率最高（365天CFRs从33.4% [95% CI, 25.8%-42.1%]到35.8% [95% CI, 28.9%-43.5%]）。这些发现表明，老年人不能从现有的创伤中心护理中受益，这些护理是为年轻患者设计的。迫切需要改进创伤护理实践，以解决老年人常见的损伤机制和损伤类型。
Is long-term mortality of injured older adults associated with the treating hospital’s trauma center level? In this population-based cohort study of long-term mortality among 433 169 older Medicare beneficiaries with injuries, mortality rates did not vary by trauma center status. These findings suggest that older adults do not benefit from existing trauma center care in the same ways as younger adults, indicating a need for revised trauma care guidelines and clinical practices that meet the needs of injured older adults. This cohort study assesses the association between mortality rates of older adults with injuries and the treating hospital’s trauma center level. Trauma centers improve outcomes for young patients with serious injuries. However, most injury-related hospital admissions and deaths occur in older adults, and it is not clear whether trauma center care provides the same benefit in this population. To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital’s trauma center level. This prospective, population-based cohort study used Medicare claims data from January 1, 2013, to December 31, 2016, for all fee-for-service Medicare beneficiaries 66 years or older with inpatient admission for traumatic injury in 2014 to 2015. Data analysis was performed from January 1 to June 31, 2021. Preinjury health was measured using 2013 claims, and outcomes were measured through 2016. The population was stratified by anatomical injury pattern. Propensity scores for level I trauma center treatment were estimated using the Abbreviated Injury Scale, age, and residential proximity to trauma center and then used to match beneficiaries from each trauma level (I, II, III, and IV/non-trauma centers) by injury type. Admitting hospital’s trauma center level. Case fatality rates (CFRs) at 30 and 365 days after injury, estimated in the matched sample using multivariable, hierarchical logistic regression models. A total of 433 169 Medicare beneficiaries (mean [SD] age, 82.9 [8.3] years; 68.4% female; 91.5% White) were included in the analysis. A total of 206 275 (47.6%) were admitted to non-trauma centers and 161 492 (37.3%) to level I or II trauma centers. Patients with isolated extremity fracture had the fewest deaths (365-day CFR ranged from 16.1% [95% CI, 11.2%-22.4%] to 17.4% [95% CI, 11.8%-24.6%] by trauma center status). Patients with both hip fracture and traumatic brain injury had the most deaths (365-day CFRs ranged from 33.4% [95% CI, 25.8%-42.1%] to 35.8% [95% CI, 28.9%-43.5%]). These findings suggest that older adults do not benefit from existing trauma center care, which is designed with younger patients in mind. There is a critical need to improve trauma care practices to address common injury mechanisms and types of injury in older adults.
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影响因子：
3.9
作者：
Mues KE;Liede A;Liu J;Wetmore JB;Zaha R;Bradbury BD;Collins AJ;Gilbertson DT
通讯作者：
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DOI：
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影响因子：
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DOI：
10.1093/gerona/glx229
发表时间：
2018-07-01
影响因子：
5.1
作者：
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通讯作者：
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