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Do trauma center levels matter in older isolated hip fracture patients?

  • Howard Nelson-Williams
    Affiliations
    Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland

    Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland
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  • Lisa Kodadek
    Affiliations
    Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland

    Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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  • Joseph Canner
    Affiliations
    Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland

    Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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  • Eric Schneider
    Affiliations
    Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland

    Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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  • David Efron
    Affiliations
    Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland

    Division of Acute Care Surgery and Adult Trauma Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland
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  • Elliott Haut
    Affiliations
    Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland

    Department of Surgery, Anesthesiology / Critical Care Medicine (ACCM), Emergency Medicine, Johns Hopkins University, Baltimore, Maryland

    Health Policy & Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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  • Babar Shafiq
    Affiliations
    Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
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  • Adil Haider
    Affiliations
    Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland

    Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts
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  • Catherine Garrison Velopulos
    Correspondence
    Corresponding author. Division of Acute Care Surgery and Adult Trauma Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 6107, Baltimore, MD 21287. Tel.: +1 410 955 2244; fax: +1 410 614 3833.
    Affiliations
    Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland

    Division of Acute Care Surgery and Adult Trauma Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland
    Search for articles by this author
Published:April 18, 2015DOI:https://doi.org/10.1016/j.jss.2015.03.074

      Abstract

      Background

      Younger, multi-trauma patients have improved survival when treated at a trauma center. Many regions now propose that older patients be triaged to a higher level trauma centers (HLTCs—level I or II) versus lower level trauma centers (LLTCs—level III or nondesignated TC), even for isolated injury, despite the absence of an established benefit in this elderly cohort. We therefore sought to determine if older isolated hip fracture patients have improved survival outcomes based on trauma center level.

      Methods

      A retrospective cohort of 1.07 million patients in The Nationwide Emergency Department Sample from 2006–2010 was used to identify 239,288 isolated hip fracture patients aged ≥65 y. Multivariable logistic regression was performed controlling for patient- and hospital-level variables. The main outcome measures were inhospital mortality and discharge disposition.

      Results

      Unadjusted logistic regression analyses revealed 8% higher odds of mortality (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.00–1.16) and 10% lower odds of being discharged home (OR, 0.90; 95% CI, 0.80–1.00) among patients admitted to an HLTC versus LLTC. After controlling for patient- and hospital-level factors, neither the odds of mortality (OR, 1.06; 95% CI, 0.97–1.15) nor the odds of discharge to home (OR, 0.98; 95% CI, 0.85–1.12) differed significantly between patients treated at an HLTC versus LLTC.

      Conclusions

      Among patients with isolated hip fractures admitted to HLTCs, mortality and discharge disposition do not differ from similar patients admitted to LLTCs. These findings have important implications for trauma systems and triage protocols.

      Keywords

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