A recent study by researchers using the American College of Surgeons (ACS) National Trauma Databank (NTDB) reveals trauma centers that excel in the care of severely injured young patients do not necessarily provide the same quality of care to elderly ones.
Published in the January 2011 issue of Annals of Surgery, the study cited growing evidence that elderly injured patients have unique needs, which helped researchers identify some ways in which trauma centers can improve their care of the elderly. The researchers analyzed data on 87,754 trauma patients of all ages treated at 132 facilities. One trauma center was located in Canada, and the rest were located in the United States. About one in four patients were elderly.
The study compared the performance of these 132 facilities, identifying centers with both the highest and lowest death rates. When patients in all age groups were studied together, 14 centers were high performers, with lower than expected rates of death. When young and elderly patients were considered separately, seven centers were high performers for young patients, and nine were high performers for the elderly. However, there was little overlap: only two centers were high performers for both the young and the elderly.
“Today trauma centers are seeing a lot more elderly patients, and what we've shown is that taking the same approach to care for young patients doesn't necessarily benefit the elderly patient,” said a researcher from the University of Toronto.
Elderly patients, for example, are more likely to have coexisting diseases than younger patients, such as heart disease, lung disease, and diabetes, researchers said. Medications such as blood thinners must also be considered. Elderly persons are also more likely to have reduced organ function, what physicians describe as “physiologic reserve,” further complicating their ability to recover from injuries, researchers said.
The study reveals that the elderly patients seen most often in trauma centers are women, and the elderly as a whole are more likely to have suffered blunt injuries, specifically from falls. Severe head and leg injuries were also more predominant in the elderly.
Researchers pointed out two approaches that may lead to better results among elderly trauma patients. One involves putting intensive care patients under the care of an intensive care specialist, or an intensivist, once he or she is moved from the emergency room to the intensive care unit. The second involves more frequent use of the expertise of geriatricians who specialize in the care of the elderly.
“The collaboration between a trauma surgeon, intensivist, and a geriatric specialist would provide all the critical resources to ensure the best possible care for these patients,” researchers said.