Understanding the Benefit of Trauma Center Triage for Injured Older Adults

了解创伤中心分诊对受伤老年人的好处

• 批准号: 9324118
• 负责人: Derek DeLia
• 金额: $ 7.91万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9324118
• 关键词: Accounting; Admission activity; Adult; Affect; Age; Area; Benchmarking; Blood Pressure; Caring; Cause of Death; Cessation of life; Characteristics; Clinical; Comorbidity; Complication; Data; Data Set; Databases; Death Certificates; Development; Effectiveness; Elderly; Emergency department visit; Equilibrium; Glasgow Coma Scale; Goals; Guidelines; Health Services Research; Hospitalization; Hospitals; Individual; Injury; Inpatients; Knowledge; Life; Link; Measures; Medical; Methods; Mission; Modeling; New Jersey; Nursing Homes; Outcome; Outcome Assessment; Patients; Physiological; Population; Process; Protocols documentation; Public Health; Quality of Care; Records; Research; Research Personnel; Severities; Subgroup; Testing; Time; Trauma; Trauma patient; Traumatic injury; Triage; United States National Institutes of Health; Variant; Work; base; cohort; cost; disability; evidence base; improved; injured; injury burden; innovation; mortality; population based; precision medicine; success; trauma care; trauma centers; treatment center; young adult

ABSTRACT The objective of this R03 proposal is to examine the benefit of triage to a trauma center for injured older adults, whether this benefit is heterogeneous according to clinical characteristics, and whether differences in survival following complications explain why trauma center care has not been as beneficial for older adults as it has been for younger adults. This is a significant area of inquiry because injury is the leading cause of loss of independence in older adults, also accounting for over 840,000 hospitalizations, 80,000 deaths, and $63.9 billion in costs in 2013. Triage and treatment in a trauma center have been shown to reduce mortality from serious injuries by at least 25% in patients under 55. However, the evidence base for the benefit of trauma center care for older adults is limited, even though injury mortality increases exponentially after the age of 55. This lack of evidence is problematic given: 1) current triage guidelines consider an age > 55 as a special consideration for triage to a trauma center despite the paucity of evidence for this approach; and 2) the majority of injured elderly adults prefer to be transported by EMS to their local hospital. Our long-term goal is to apply a “precision medicine” approach to the care of injured older adults by leveraging population-level databases to guide the real-time determination of whether injured older adults would benefit from trauma center care based on their clinical characteristics. We also seek to identify what inhospital care processes are most needed to increase healthy survival. In this proposal, we will use a previously created dataset from a prior R01 to analyze all injured adults > 55 years old (N=31,884) with linked prehospital EMS electronic records, hospital data, and death certificates from New Jersey (2009-10). Our aims are to: (1) determine whether 60- day mortality for all and specific subgroups of injured older adults differs by EMS transport to a trauma center vs. non-trauma center; and (2) explore whether complication rates and 60-day mortality for injured older adults with complications differ by EMS transport to a trauma center vs. non-trauma center. This work is high impact because it will (1) yield a well-powered, unbiased estimate of the association between EMS triage to a trauma center and clinical outcomes for older adults; and (2) it will benchmark, for the first time, complication- associated mortality rates in trauma centers and non-trauma centers. The approach is innovative because it uses linked prehospital physiologic data with hospital and death certificate data to examine variation in outcomes in statewide cohort of injured older adults and it will use instrumental variable modeling adjust for unmeasured confounding. The proposed research is significant because our findings will enable the further development and testing of revised, more precise trauma triage protocols, and it will provide actionable targets for inpatient care quality improvement. This has the potential to improve the effectiveness, efficiency, and patient-centeredness of field triage, by elucidating the trauma center treatment benefit among older adults.

摘要 本R 03提案的目的是检查伤检分类对受伤老年人创伤中心的益处， 根据临床特征，这种获益是否具有异质性，以及生存率是否存在差异 以下并发症解释了为什么创伤中心的护理对老年人没有那么有益， 对于年轻人来说。这是一个重要的调查领域，因为伤害是造成损失的主要原因 老年人的独立，也占840，000多住院，80，000死亡，63.9美元 2013年的10亿元。创伤中心的分诊和治疗已被证明可以降低 55岁以下的患者中至少有25%的严重损伤。然而，创伤益处的证据基础 尽管55岁以后受伤死亡率呈指数增长，但对老年人的中心护理是有限的。 这种缺乏证据的情况是有问题的：1）目前的分诊指南认为年龄> 55岁是一个特殊的 考虑分诊到创伤中心，尽管这种方法缺乏证据; 2） 大多数受伤的老年人更愿意由EMS运送到当地医院。我们的长期目标是 通过利用人口水平，将“精确医学”方法应用于受伤老年人的护理 数据库，以指导实时确定受伤的老年人是否会从创伤中受益 根据其临床特征进行中心护理。我们还试图确定什么是住院护理过程 最需要的是提高健康的生存率。在本提案中，我们将使用先前创建的数据集， R 01分析所有> 55岁的受伤成人（N= 31，884），并链接院前EMS电子记录， 医院数据和新泽西的死亡证明（2009-10）。我们的目标是：（1）确定60- EMS运送到创伤中心的所有和特定亚组受伤老年人的日死亡率不同 vs.非创伤中心;（2）探讨老年人受伤后的并发症发生率和60天死亡率 EMS运送到创伤中心与非创伤中心的并发症不同。这项工作影响很大 因为它将（1）对EMS分诊与创伤之间的关联做出有力、公正的估计 老年人的中心和临床结果;（2）它将首次基准化并发症- 创伤中心和非创伤中心的相关死亡率。这种方法是创新的，因为它 使用与医院和死亡证明数据相关联的院前生理数据来检查 结果在全州队列受伤的老年人，它将使用工具变量模型调整， 不可测量的混杂。拟议的研究是重要的，因为我们的发现将使进一步的 开发和测试经修订的、更精确的创伤分诊协议，并将提供可操作的目标 提高住院病人护理质量。这有可能提高有效性、效率和 以病人为中心的现场分诊，通过阐明创伤中心治疗老年人的好处。