The relationship between processes and outcomes for injured older adults: a study of a statewide trauma system

N. N. Saillant, E. Earl-Royal, J. L. Pascual, S. R. Allen, P. K. Kim, M. K. Delgado, B. G. Carr, D. Wiebe, D. N. Holena

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: Age is a risk factor for death, adverse outcomes, and health care use following trauma. The American College of Surgeons’ Trauma Quality Improvement Program (TQIP) has published “best practices” of geriatric trauma care; adoption of these guidelines is unknown. We sought to determine which evidence-based geriatric protocols, including TQIP guidelines, were correlated with decreased mortality in Pennsylvania’s trauma centers. Methods: PA’s level I and II trauma centers self-reported adoption of geriatric protocols. Survey data were merged with risk-adjusted mortality data for patients ≥65 from a statewide database, the Pennsylvania Trauma Systems Foundation (PTSF), to compare mortality outlier status and processes of care. Exposures of interest were center-specific processes of care; outcome of interest was PTSF mortality outlier status. Results: 26 of 27 eligible trauma centers participated. There was wide variation in care processes. Four trauma centers were low outliers; three centers were high outliers for risk-adjusted mortality rates in adults ≥65. Results remained consistent when accounting for center volume. The only process associated with mortality outlier status was age-specific solid organ injury protocols (p = 0.04). There was no cumulative effect of multiple evidence-based processes on mortality rate (p = 0.50). Conclusions: We did not see a link between adoption of geriatric best-practices trauma guidelines and reduced mortality at PA trauma centers. The increased susceptibility of elderly to adverse consequences of injury, combined with the rapid growth rate of this demographic, emphasizes the importance of identifying interventions tailored to this population. Level of evidence: III. Study type: Descriptive.

Original languageEnglish (US)
Pages (from-to)121-127
Number of pages7
JournalEuropean Journal of Trauma and Emergency Surgery
Volume43
Issue number1
DOIs
StatePublished - Feb 1 2017

Fingerprint

Trauma Centers
Wounds and Injuries
Mortality
Geriatrics
Practice Guidelines
Quality Improvement
Guidelines
Demography
Databases
Delivery of Health Care
Growth
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Saillant, N. N. ; Earl-Royal, E. ; Pascual, J. L. ; Allen, S. R. ; Kim, P. K. ; Delgado, M. K. ; Carr, B. G. ; Wiebe, D. ; Holena, D. N. / The relationship between processes and outcomes for injured older adults : a study of a statewide trauma system. In: European Journal of Trauma and Emergency Surgery. 2017 ; Vol. 43, No. 1. pp. 121-127.
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The relationship between processes and outcomes for injured older adults : a study of a statewide trauma system. / Saillant, N. N.; Earl-Royal, E.; Pascual, J. L.; Allen, S. R.; Kim, P. K.; Delgado, M. K.; Carr, B. G.; Wiebe, D.; Holena, D. N.

In: European Journal of Trauma and Emergency Surgery, Vol. 43, No. 1, 01.02.2017, p. 121-127.

Research output: Contribution to journalArticle

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AU - Saillant, N. N.

AU - Earl-Royal, E.

AU - Pascual, J. L.

AU - Allen, S. R.

AU - Kim, P. K.

AU - Delgado, M. K.

AU - Carr, B. G.

AU - Wiebe, D.

AU - Holena, D. N.

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N2 - Purpose: Age is a risk factor for death, adverse outcomes, and health care use following trauma. The American College of Surgeons’ Trauma Quality Improvement Program (TQIP) has published “best practices” of geriatric trauma care; adoption of these guidelines is unknown. We sought to determine which evidence-based geriatric protocols, including TQIP guidelines, were correlated with decreased mortality in Pennsylvania’s trauma centers. Methods: PA’s level I and II trauma centers self-reported adoption of geriatric protocols. Survey data were merged with risk-adjusted mortality data for patients ≥65 from a statewide database, the Pennsylvania Trauma Systems Foundation (PTSF), to compare mortality outlier status and processes of care. Exposures of interest were center-specific processes of care; outcome of interest was PTSF mortality outlier status. Results: 26 of 27 eligible trauma centers participated. There was wide variation in care processes. Four trauma centers were low outliers; three centers were high outliers for risk-adjusted mortality rates in adults ≥65. Results remained consistent when accounting for center volume. The only process associated with mortality outlier status was age-specific solid organ injury protocols (p = 0.04). There was no cumulative effect of multiple evidence-based processes on mortality rate (p = 0.50). Conclusions: We did not see a link between adoption of geriatric best-practices trauma guidelines and reduced mortality at PA trauma centers. The increased susceptibility of elderly to adverse consequences of injury, combined with the rapid growth rate of this demographic, emphasizes the importance of identifying interventions tailored to this population. Level of evidence: III. Study type: Descriptive.

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