The impact of trauma center care on one-year outcomes among injured older adults: a population-based cohort study

Objective — To evaluate the impact of trauma center care on one-year mortality among injured older adults.

Background — Older adults represent the fastest growing population of injured patients, however the long-term benefit of trauma center care among these patients is unknown.

Methods — We performed a population-based cohort study of individuals age ≥ 65 with moderate or severe injuries (presence of an American College of Surgeons defined critical injury, Injury Severity Score [ISS] ≥ 9, or death within 24hrs) who presented to a hospital in Ontario, Canada between 2009-2020. Patients with isolated hip fractures were excluded. Differential distance between the nearest trauma and non-trauma centers was used in an adjusted instrumental variable analysis to estimate the impact of trauma center care on mortality. Stratified analyses were performed to evaluate the effect of age, injury severity, and isolated severe head injuries on the relationship between trauma center care and one-year outcomes.

Results — Among 55,799 injured older adults, 15,857 (28.4%) were treated at a trauma center. The overall one-year mortality was 27.4% (n=15,285). Adjusted analysis demonstrated that trauma center care was associated with a 3.5% (95% CI: 1.2-5.8%) absolute decrease in one-year mortality. The beneficial effect of trauma center care was consistent across age groups and both moderate and severe injuries. However, patients with isolated brain injuries appeared to derive no benefit from trauma center care (one-year mortality difference -1.3% [95% CI -4.1-1.5%]).

Conclusion and relevance — Among older adults with moderate or severe injuries, trauma center care was associated with reduced one-year mortality. These findings highlight the importance of trauma center care among older adults and suggest that a lower threshold for transfer of these patients may be beneficial.