Long-term outcomes among injured older adults transported by emergency medical services

Craig Newgard, Amber Lin, Norbert Yanez, Eileen Bulger, Susan Malveau, Aaron Caughey, Kenneth (John) McConnell, Dana Zive, Denise Griffiths, Rahill Mirlohi, Elizabeth Eckstrom

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction/Objective: Little is known about the long-term outcomes of injured older adults cared for in trauma systems. We sought to describe mortality and causes of death over time, and the independent association of injury severity, comorbidities, and other factors on 12-month mortality among injured older adults transported by emergency medical services (EMS). Materials and Methods: This was a population-based cohort study of injured adults ≥ 65 years in the United States transported by 44 EMS agencies to 51 hospitals from January 1, 2011 to December 31, 2011, with 12-month follow-up through December 31, 2012. The primary outcomes were time to death and causes of death. We used descriptive statistics and Cox proportional hazards models to generate adjusted hazard ratios (HR). Results: 15,649 injured older adults were transported by EMS, frequently after a fall (84.5%). Serious injuries (Injury Severity Score [ISS] ≥ 16) occurred in 3.5%, with serious extremity injury (Abbreviated Injury Scale score ≥ 3) being most common (17.8%). Mortality rates were: 1.6% in-hospital, 5.1% at 30 days, 9.4% at 90 days and 20.3% at 1 year. The adjusted HR for patients in the highest comorbidity quartile was 2.20 (versus lowest quartile, 95% CI 1.97–2.46, p < .001), while the HR for ISS ≥ 25 was 2.69 (versus ISS 0–8, 95% CI 1.60–4.51, p = .001). Cardiovascular etiologies (53.3%) and dementia (32.7%) were the most common causes of death, with injury listed in 12.8% of death certificates. Conclusions: Injury requiring EMS transport is a sentinel event among older adults, with death typically occurring months later, often due to cardiovascular causes and dementia. A heavy comorbidity burden had an adjusted mortality risk comparable to severe injury.

Original languageEnglish (US)
JournalInjury
DOIs
StatePublished - Jan 1 2019

Fingerprint

Emergency Medical Services
Wounds and Injuries
Injury Severity Score
Comorbidity
Cause of Death
Mortality
Dementia
Abbreviated Injury Scale
Death Certificates
Proportional Hazards Models
Cohort Studies
Extremities
Population

Keywords

  • Elderly
  • Emergency medical services
  • Older adult
  • Outcomes
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Long-term outcomes among injured older adults transported by emergency medical services. / Newgard, Craig; Lin, Amber; Yanez, Norbert; Bulger, Eileen; Malveau, Susan; Caughey, Aaron; McConnell, Kenneth (John); Zive, Dana; Griffiths, Denise; Mirlohi, Rahill; Eckstrom, Elizabeth.

In: Injury, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Long-term outcomes among injured older adults transported by emergency medical services",
abstract = "Introduction/Objective: Little is known about the long-term outcomes of injured older adults cared for in trauma systems. We sought to describe mortality and causes of death over time, and the independent association of injury severity, comorbidities, and other factors on 12-month mortality among injured older adults transported by emergency medical services (EMS). Materials and Methods: This was a population-based cohort study of injured adults ≥ 65 years in the United States transported by 44 EMS agencies to 51 hospitals from January 1, 2011 to December 31, 2011, with 12-month follow-up through December 31, 2012. The primary outcomes were time to death and causes of death. We used descriptive statistics and Cox proportional hazards models to generate adjusted hazard ratios (HR). Results: 15,649 injured older adults were transported by EMS, frequently after a fall (84.5{\%}). Serious injuries (Injury Severity Score [ISS] ≥ 16) occurred in 3.5{\%}, with serious extremity injury (Abbreviated Injury Scale score ≥ 3) being most common (17.8{\%}). Mortality rates were: 1.6{\%} in-hospital, 5.1{\%} at 30 days, 9.4{\%} at 90 days and 20.3{\%} at 1 year. The adjusted HR for patients in the highest comorbidity quartile was 2.20 (versus lowest quartile, 95{\%} CI 1.97–2.46, p < .001), while the HR for ISS ≥ 25 was 2.69 (versus ISS 0–8, 95{\%} CI 1.60–4.51, p = .001). Cardiovascular etiologies (53.3{\%}) and dementia (32.7{\%}) were the most common causes of death, with injury listed in 12.8{\%} of death certificates. Conclusions: Injury requiring EMS transport is a sentinel event among older adults, with death typically occurring months later, often due to cardiovascular causes and dementia. A heavy comorbidity burden had an adjusted mortality risk comparable to severe injury.",
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author = "Craig Newgard and Amber Lin and Norbert Yanez and Eileen Bulger and Susan Malveau and Aaron Caughey and McConnell, {Kenneth (John)} and Dana Zive and Denise Griffiths and Rahill Mirlohi and Elizabeth Eckstrom",
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T1 - Long-term outcomes among injured older adults transported by emergency medical services

AU - Newgard, Craig

AU - Lin, Amber

AU - Yanez, Norbert

AU - Bulger, Eileen

AU - Malveau, Susan

AU - Caughey, Aaron

AU - McConnell, Kenneth (John)

AU - Zive, Dana

AU - Griffiths, Denise

AU - Mirlohi, Rahill

AU - Eckstrom, Elizabeth

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction/Objective: Little is known about the long-term outcomes of injured older adults cared for in trauma systems. We sought to describe mortality and causes of death over time, and the independent association of injury severity, comorbidities, and other factors on 12-month mortality among injured older adults transported by emergency medical services (EMS). Materials and Methods: This was a population-based cohort study of injured adults ≥ 65 years in the United States transported by 44 EMS agencies to 51 hospitals from January 1, 2011 to December 31, 2011, with 12-month follow-up through December 31, 2012. The primary outcomes were time to death and causes of death. We used descriptive statistics and Cox proportional hazards models to generate adjusted hazard ratios (HR). Results: 15,649 injured older adults were transported by EMS, frequently after a fall (84.5%). Serious injuries (Injury Severity Score [ISS] ≥ 16) occurred in 3.5%, with serious extremity injury (Abbreviated Injury Scale score ≥ 3) being most common (17.8%). Mortality rates were: 1.6% in-hospital, 5.1% at 30 days, 9.4% at 90 days and 20.3% at 1 year. The adjusted HR for patients in the highest comorbidity quartile was 2.20 (versus lowest quartile, 95% CI 1.97–2.46, p < .001), while the HR for ISS ≥ 25 was 2.69 (versus ISS 0–8, 95% CI 1.60–4.51, p = .001). Cardiovascular etiologies (53.3%) and dementia (32.7%) were the most common causes of death, with injury listed in 12.8% of death certificates. Conclusions: Injury requiring EMS transport is a sentinel event among older adults, with death typically occurring months later, often due to cardiovascular causes and dementia. A heavy comorbidity burden had an adjusted mortality risk comparable to severe injury.

AB - Introduction/Objective: Little is known about the long-term outcomes of injured older adults cared for in trauma systems. We sought to describe mortality and causes of death over time, and the independent association of injury severity, comorbidities, and other factors on 12-month mortality among injured older adults transported by emergency medical services (EMS). Materials and Methods: This was a population-based cohort study of injured adults ≥ 65 years in the United States transported by 44 EMS agencies to 51 hospitals from January 1, 2011 to December 31, 2011, with 12-month follow-up through December 31, 2012. The primary outcomes were time to death and causes of death. We used descriptive statistics and Cox proportional hazards models to generate adjusted hazard ratios (HR). Results: 15,649 injured older adults were transported by EMS, frequently after a fall (84.5%). Serious injuries (Injury Severity Score [ISS] ≥ 16) occurred in 3.5%, with serious extremity injury (Abbreviated Injury Scale score ≥ 3) being most common (17.8%). Mortality rates were: 1.6% in-hospital, 5.1% at 30 days, 9.4% at 90 days and 20.3% at 1 year. The adjusted HR for patients in the highest comorbidity quartile was 2.20 (versus lowest quartile, 95% CI 1.97–2.46, p < .001), while the HR for ISS ≥ 25 was 2.69 (versus ISS 0–8, 95% CI 1.60–4.51, p = .001). Cardiovascular etiologies (53.3%) and dementia (32.7%) were the most common causes of death, with injury listed in 12.8% of death certificates. Conclusions: Injury requiring EMS transport is a sentinel event among older adults, with death typically occurring months later, often due to cardiovascular causes and dementia. A heavy comorbidity burden had an adjusted mortality risk comparable to severe injury.

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KW - Emergency medical services

KW - Older adult

KW - Outcomes

KW - Trauma

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