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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Article info
Publication history
Published online: April 18, 2015
Accepted:
March 25,
2015
Received in revised form:
March 16,
2015
Received:
December 19,
2014
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
