The influence of sociodemographic factors on trauma center transport for severely injured older adults.

Objective: To examine sociodemographic predictors of trauma center (TC) transport of severely injured older adults.

Data Sources: The data source was the Healthcare Cost and Utilization Project, New York Inpatient Database (2014).

Study Design: This study was a secondary analysis of injured older adults.

Complications and Mortality Among Correctly Triaged and Undertriaged Severely Injured Older Adults With Traumatic Brain Injuries.

Determining differences in clinical outcomes of older adults treated at trauma centers (TCs) and nontrauma centers (NTCs) is imperative considering their persistent undertriage and the projected costs of fixing the problem. This study compared the incidence and predictors of complications and mortality among brain-injured older adults treated at TCs and NTCs. This secondary analysis of New York inpatient data included patients aged 55+ years, primary brain injury diagnosis, and acute care hospital admission.

Early neurological deterioration in older adults with traumatic brain injury.

Introduction: Traumatic brain injuries (TBIs) and resulting fatalities among older adults increased considerably in recent years. Neurological deterioration often goes unrecognized at the injury scene and patients arrive at emergency departments with near-normal Glasgow Coma Scale (GCS) scores. This study examined the proportion of older adults experiencing early neurological deterioration (prehospital to emergency department), associated factors, and association of the magnitude of neurological deterioration with TBI severity.

One for the Road: A Comparison of Drinking and Driving Behavior Among Younger and Older Adults Involved in Fatal Crashes.

Driving while intoxicated has been widely studied, but little is known about the differences in driving behaviors between the youngest and oldest drivers who consume alcohol but are not intoxicated. This study examined factors leading to fatal crashes in younger and older drivers who consumed alcohol, with a focus on drivers whose blood alcohol concentration was less than 0.08%.

Injury patterns, severity and outcomes among older adults who sustained brain injury following a same level fall: a retrospective analysis.

Introduction: The objectives of this study were to: identify the incidence and types of brain injuries; classify brain injury severity; identify additional injuries; and identify predictors of length of stay, mortality and trauma center admission.

Methods: This secondary analysis used the NY State Inpatient Databases Healthcare Cost and Utilization Project. Inclusion criteria were: age 65 years and older, admitted to a hospital following a same level fall, primary hospital discharge diagnosis of traumatic brain injury.

Comparison of type and severity of major injuries among undertriaged and correctly triaged older patients.

Background: Despite the use of prehospital triage algorithms and other trauma scoring methods, a substantial proportion of older patients with life-threatening injuries are undertriaged, increasing the risk of preventable death and disability.

Study Objective: The primary objective of this study was to describe the injury types, injury severity, and short-term survival outcomes of undertriaged older adults injured in motor vehicle collisions, compared to a group of correctly triaged older adults.

Methods: This secondary analysis of records extracted from the National Automotive Sampling System Crashworthiness Data System for the years 2004 through 2008 compared persons aged 65 years and older who sustained maximum Abbreviated Injury Scale (mAIS) 3, 4, and 5 injuries and were transported to non-trauma center hospitals to those with mAIS 3, 4, and 5 injuries who were transported to trauma center hospitals.

Life-threatening injuries in older adults.

Unintentional injuries are among the leading causes of death and disability in older adults. Although older adults account for approximately 12% of the US population, in 2008, they accounted for 15% of all traffic fatalities, 14% of all vehicle occupant fatalities, and 18% of all pedestrian fatalities. Severely injured older adults have far worse outcomes than younger adults.

Trends in the accuracy of older person trauma triage from 2004 to 2008.

Background: Older injured persons are frequently undertriaged, increasing the risk for preventable mortality and morbidity in an already-vulnerable population. Changes made in 2006 to the American College of Surgeons Committee on Trauma (ACS-COT) Field Triage Decision Scheme might improve triage accuracy for this population.

Objective: This study examined triage accuracy before and after the 2006 revisions.

Prehospital factors associated with severe injury in older adults.

Introduction: Globally, injury is amongst the leading causes of death and disability in all age groups. Despite the use of prehospital trauma triage guidelines, identification of older persons with severe,potentially life-threatening injuries has been problematic. The purpose of this paper is to review prehospital factors associated with severe injuries amongst older adults.

Classification tree modeling to identify severe and moderate vehicular injuries in young and middle-aged adults.

Objectives: Motor vehicle crashes are a leading cause of mortality and morbidity worldwide. Even though trauma centers provide the gold standard of care for motor vehicle crash patients with life- or limb-threatening injuries, many whose lives might be saved by trauma center care are treated instead at non-trauma center hospitals. Triage algorithms, designed to identify patients with life- or limb-threatening injuries who should be transported to a trauma center, lack appropriate sensitivity to many of these injuries.

Evaluation of injury databases as a preliminary step to developing a triage decision rule.

Purpose: To evaluate accessibility and appropriateness of the Crash Outcomes Data Evaluation Systems (CODES) databases for prehospital trauma triage decision-rule development for people age 65 years and older.

Design And Methods: This informatics feasibility study included five steps for evaluating the accessibility of CODES databases. Eight criteria were used to evaluate the appropriateness of these databases for older person prehospital trauma triage decision-rule development.

Using crash scene variables to predict the need for trauma center care in older persons.

Current trauma triage protocols lack sensitivity to occult injuries in older persons, resulting in unacceptable undertriage rates. We identified crash scene information that could be used by emergency personnel to identify the need for trauma center care in older persons injured in motor vehicle crashes. Crash records of 7,883 persons 65 years and older were explored using classification and regression trees (CART) analysis.

Differences in survival, length of stay, and discharge disposition of older trauma patients admitted to trauma centers and nontrauma center hospitals.

Purpose: To examine the relationship of level of care (trauma center [TC], nontrauma center [NTC] hospitals) on three outcomes: survival, length of stay, and discharge disposition.

Design: Retrospective secondary analysis of a subset of data (1,418 patients age 65 to 99 years) from a large statewide study in which the purpose was to compare admission patterns (TCs and NTCs) of motor vehicle (MV) trauma patients according to age and sex. The New Jersey UB-92 Patient Discharge Data for 2000 were used in this analysis.

Relationship of age, injury severity, injury type, comorbid conditions, level of care, and survival among older motor vehicle trauma patients.

The purpose of this secondary data analysis was to compare age, injury severity, injury types, selected comorbidities, level of care (at trauma center [TC] and non-trauma center [NTC] hospitals), and survival among older motor vehicle trauma patients (N = 1,478). Patients admitted to both levels of care had similar comorbid conditions. TC patients had a higher injury severity, whereas NTC patients had a greater proportion of soft tissue injuries.

Trauma center versus non-trauma center admissions in adult trauma victims by age and gender.

Objective: The admission types and appropriateness of admission of adults with differing levels of injury severity were compared, based on patient age and gender.

Methods: This retrospective study used a statewide hospital discharge dataset. The patients included adults who had sustained trauma related to motor vehicles and were admitted to trauma center (TCs) and non-trauma center (NTCs) hospitals.

Effectiveness of prehospital trauma triage guidelines for the identification of major trauma in elderly motor vehicle crash victims.

Introduction: Undertriage of older trauma victims has been a persistent and serious problem. Because of physiologic changes and pre-existing disease, blunt trauma in older persons is often covert. Prehospital trauma triage guidelines developed for use with a general adult population may not be sensitive enough to detect covert injuries in elderly trauma patients.