Direct transport of geriatric trauma patients with pelvic fractures to a Level I trauma center within an organized trauma system: impact on two-week incidence of in-hospital complications

• Published in: The American journal of surgery Vol. 204; no. 6; pp. 921 - 926
• Main Authors: Garwe, Tabitha, Ph.D, Roberts, Zachary V., M.D, Albrecht, Roxie M., M.D, Morgan, Ashley E., M.D, Johnson, Jeremy J., M.D, Neas, Barbara R., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-2012; Elsevier; Elsevier Limited
• Subjects: Abbreviated Injury Scale; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Complications; Direct transport; Epidemiology; Female; Fracture Fixation; Fractures, Bone - complications; Fractures, Bone - diagnosis; Fractures, Bone - therapy; General aspects; Geriatric trauma; Hospitals; Humans; Incidence; Level I trauma center; Logistic Models; Male; Medical sciences; Middle Aged; Miscellaneous; Mortality; Patient Transfer; Pelvic Bones - injuries; Pelvic fracture; Pneumonia - epidemiology; Pneumonia - etiology; Poisson Distribution; Public health. Hygiene; Public health. Hygiene-occupational medicine; Respiratory distress syndrome; Retrospective Studies; Surgery; Systemic Inflammatory Response Syndrome - epidemiology; Systemic Inflammatory Response Syndrome - etiology; Transportation of Patients; Trauma Centers; Triage; Level I trauma center; Triage; Pelvic fracture; Direct transport; Complications; Geriatric trauma; Diseases of the osteoarticular system; Fracture; Epidemiology; Incidence; Direct method; Pelvic cavity; Surgery; Complication; Hospital; Public health; Human; Center; Hospitalization; Trauma; Sorting; Medicine; Treatment; Emergency; Transport; Elderly; Geriatrics
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2012.05.020

Abstract Background Undertriage of elderly trauma patients to tertiary trauma centers is well documented. This study evaluated the impact of directness of transport to a Level I trauma center on morbidity in geriatric trauma patients sustaining severe pelvic fractures. Methods This was a retrospective cohort study of 87 geriatric trauma patients diagnosed with potentially unstable pelvic fractures, treated at a Level I trauma center between 2008 and 2010. Results Of the 87 patients, 39% (34 of 87) initially were transported to a nontertiary trauma center. After adjusting for presence of comorbidity and injury severity, the 2-week incidence of complications was 54% higher in transferred patients compared with those directly transported (rate ratio, 1.54; 95% confidence interval, .95–2.54). In particular, transferred patients had increased odds of developing pneumonia/systemic inflammatory response syndrome. Conclusions Despite lacking precision, results of this study suggest an increased risk of complications in transferred geriatric trauma patients with severe pelvic fractures compared with their directly transported counterparts.