Out-of-hospital and Inter-hospital Under-triage to Designated Tertiary Trauma Centers among Injured Older Adults

A 10-year Statewide Geospatial-Adjusted Analysis

Tabitha Garwe, Kenneth Stewart, Julie Stoner, Craig Newgard, Melissa Scott, Ying Zhang, Timothy Cathey, John Sacra, Roxie M. Albrecht

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: While out-of-hospital under-triage of seriously injured older adults to tertiary trauma centers has long been acknowledged, no study has adjusted for place of injury or evaluated the extent of inter-facility under-triage. We sought to determine distance and confounder adjusted odds of treatment at a tertiary trauma center (TTC) for older adult trauma patients compared to younger trauma patients, for patients transported from the scene of injury and those transferred from a non-tertiary trauma (NTTC) center. Methods: This was a retrospective cohort study utilizing data from a statewide trauma registry reported over a 10-year period (2005–14). The outcome of interest was treatment at an American College of Surgeons or state-designated Level I/II trauma center (TTC). The predictor variable of interest was age group (> = 55 years vs. < 55 years). Covariates of interest included patient demographics, clinical characteristics and various distance measures calculated based on the patient's injury location. Results: 84 930 patients met study criteria. Of these 42% (35659) were 55 years and older with an average age of 74 years (SD, 11.6). Older adult patients were on average, injured slightly farther away from a TTC (median distance, 34 vs. 29 miles, p < 0.001). Among patients initially presenting to NTTCs, older adults were significantly more likely to be transferred to another NTTC (53% vs. 34%). After adjusting for confounders and distance measures, older adults were less likely to be treated at TTCs overall (OR = 0.54, 95% CI: 0.52–0.56), whether transported by EMS from the scene of injury (OR = 0.47, 95% CI: 0.44–0.50) or via inter-facility transfer (OR = 0.63, 95%CI: 0.59–0.68). Conclusions: Injured older adults face significant under-triage to TTCs whether by EMS from the scene of injury or via transfer from NTTCs. Adjusting for proximity of injury to a TTC does not alter these findings.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalPrehospital Emergency Care
DOIs
StateAccepted/In press - Jun 29 2017

Fingerprint

Triage
Trauma Centers
antineoplaston A10
Wounds and Injuries
Registries
Cohort Studies
Retrospective Studies
Age Groups
Demography
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Out-of-hospital and Inter-hospital Under-triage to Designated Tertiary Trauma Centers among Injured Older Adults : A 10-year Statewide Geospatial-Adjusted Analysis. / Garwe, Tabitha; Stewart, Kenneth; Stoner, Julie; Newgard, Craig; Scott, Melissa; Zhang, Ying; Cathey, Timothy; Sacra, John; Albrecht, Roxie M.

In: Prehospital Emergency Care, 29.06.2017, p. 1-10.

Research output: Contribution to journalArticle

Garwe, Tabitha ; Stewart, Kenneth ; Stoner, Julie ; Newgard, Craig ; Scott, Melissa ; Zhang, Ying ; Cathey, Timothy ; Sacra, John ; Albrecht, Roxie M. / Out-of-hospital and Inter-hospital Under-triage to Designated Tertiary Trauma Centers among Injured Older Adults : A 10-year Statewide Geospatial-Adjusted Analysis. In: Prehospital Emergency Care. 2017 ; pp. 1-10.
@article{d3b077e85f1c4cf4842119c9a333ef9c,
title = "Out-of-hospital and Inter-hospital Under-triage to Designated Tertiary Trauma Centers among Injured Older Adults: A 10-year Statewide Geospatial-Adjusted Analysis",
abstract = "Objective: While out-of-hospital under-triage of seriously injured older adults to tertiary trauma centers has long been acknowledged, no study has adjusted for place of injury or evaluated the extent of inter-facility under-triage. We sought to determine distance and confounder adjusted odds of treatment at a tertiary trauma center (TTC) for older adult trauma patients compared to younger trauma patients, for patients transported from the scene of injury and those transferred from a non-tertiary trauma (NTTC) center. Methods: This was a retrospective cohort study utilizing data from a statewide trauma registry reported over a 10-year period (2005–14). The outcome of interest was treatment at an American College of Surgeons or state-designated Level I/II trauma center (TTC). The predictor variable of interest was age group (> = 55 years vs. < 55 years). Covariates of interest included patient demographics, clinical characteristics and various distance measures calculated based on the patient's injury location. Results: 84 930 patients met study criteria. Of these 42{\%} (35659) were 55 years and older with an average age of 74 years (SD, 11.6). Older adult patients were on average, injured slightly farther away from a TTC (median distance, 34 vs. 29 miles, p < 0.001). Among patients initially presenting to NTTCs, older adults were significantly more likely to be transferred to another NTTC (53{\%} vs. 34{\%}). After adjusting for confounders and distance measures, older adults were less likely to be treated at TTCs overall (OR = 0.54, 95{\%} CI: 0.52–0.56), whether transported by EMS from the scene of injury (OR = 0.47, 95{\%} CI: 0.44–0.50) or via inter-facility transfer (OR = 0.63, 95{\%}CI: 0.59–0.68). Conclusions: Injured older adults face significant under-triage to TTCs whether by EMS from the scene of injury or via transfer from NTTCs. Adjusting for proximity of injury to a TTC does not alter these findings.",
author = "Tabitha Garwe and Kenneth Stewart and Julie Stoner and Craig Newgard and Melissa Scott and Ying Zhang and Timothy Cathey and John Sacra and Albrecht, {Roxie M.}",
year = "2017",
month = "6",
day = "29",
doi = "10.1080/10903127.2017.1332123",
language = "English (US)",
pages = "1--10",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",

}

TY - JOUR

T1 - Out-of-hospital and Inter-hospital Under-triage to Designated Tertiary Trauma Centers among Injured Older Adults

T2 - A 10-year Statewide Geospatial-Adjusted Analysis

AU - Garwe, Tabitha

AU - Stewart, Kenneth

AU - Stoner, Julie

AU - Newgard, Craig

AU - Scott, Melissa

AU - Zhang, Ying

AU - Cathey, Timothy

AU - Sacra, John

AU - Albrecht, Roxie M.

PY - 2017/6/29

Y1 - 2017/6/29

N2 - Objective: While out-of-hospital under-triage of seriously injured older adults to tertiary trauma centers has long been acknowledged, no study has adjusted for place of injury or evaluated the extent of inter-facility under-triage. We sought to determine distance and confounder adjusted odds of treatment at a tertiary trauma center (TTC) for older adult trauma patients compared to younger trauma patients, for patients transported from the scene of injury and those transferred from a non-tertiary trauma (NTTC) center. Methods: This was a retrospective cohort study utilizing data from a statewide trauma registry reported over a 10-year period (2005–14). The outcome of interest was treatment at an American College of Surgeons or state-designated Level I/II trauma center (TTC). The predictor variable of interest was age group (> = 55 years vs. < 55 years). Covariates of interest included patient demographics, clinical characteristics and various distance measures calculated based on the patient's injury location. Results: 84 930 patients met study criteria. Of these 42% (35659) were 55 years and older with an average age of 74 years (SD, 11.6). Older adult patients were on average, injured slightly farther away from a TTC (median distance, 34 vs. 29 miles, p < 0.001). Among patients initially presenting to NTTCs, older adults were significantly more likely to be transferred to another NTTC (53% vs. 34%). After adjusting for confounders and distance measures, older adults were less likely to be treated at TTCs overall (OR = 0.54, 95% CI: 0.52–0.56), whether transported by EMS from the scene of injury (OR = 0.47, 95% CI: 0.44–0.50) or via inter-facility transfer (OR = 0.63, 95%CI: 0.59–0.68). Conclusions: Injured older adults face significant under-triage to TTCs whether by EMS from the scene of injury or via transfer from NTTCs. Adjusting for proximity of injury to a TTC does not alter these findings.

AB - Objective: While out-of-hospital under-triage of seriously injured older adults to tertiary trauma centers has long been acknowledged, no study has adjusted for place of injury or evaluated the extent of inter-facility under-triage. We sought to determine distance and confounder adjusted odds of treatment at a tertiary trauma center (TTC) for older adult trauma patients compared to younger trauma patients, for patients transported from the scene of injury and those transferred from a non-tertiary trauma (NTTC) center. Methods: This was a retrospective cohort study utilizing data from a statewide trauma registry reported over a 10-year period (2005–14). The outcome of interest was treatment at an American College of Surgeons or state-designated Level I/II trauma center (TTC). The predictor variable of interest was age group (> = 55 years vs. < 55 years). Covariates of interest included patient demographics, clinical characteristics and various distance measures calculated based on the patient's injury location. Results: 84 930 patients met study criteria. Of these 42% (35659) were 55 years and older with an average age of 74 years (SD, 11.6). Older adult patients were on average, injured slightly farther away from a TTC (median distance, 34 vs. 29 miles, p < 0.001). Among patients initially presenting to NTTCs, older adults were significantly more likely to be transferred to another NTTC (53% vs. 34%). After adjusting for confounders and distance measures, older adults were less likely to be treated at TTCs overall (OR = 0.54, 95% CI: 0.52–0.56), whether transported by EMS from the scene of injury (OR = 0.47, 95% CI: 0.44–0.50) or via inter-facility transfer (OR = 0.63, 95%CI: 0.59–0.68). Conclusions: Injured older adults face significant under-triage to TTCs whether by EMS from the scene of injury or via transfer from NTTCs. Adjusting for proximity of injury to a TTC does not alter these findings.

UR - http://www.scopus.com/inward/record.url?scp=85021672840&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021672840&partnerID=8YFLogxK

U2 - 10.1080/10903127.2017.1332123

DO - 10.1080/10903127.2017.1332123

M3 - Article

SP - 1

EP - 10

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

ER -