Injuries among the elderly make up a large number of the total visits to the ER. But are the elderly getting the right amount of attention and treatment?
A new study found that about a third of elderly patients with traumatic injuries were often undertriaged, meaning they were not taken to a trauma center when their injuries warranted being seen in those facilities.
According to the researchers, their findings reveal the need to understand and address injury patterns and care among elderly patients.
"Keep an eye on elderly family members."
Kristan L. Staudenmayer, MD, assistant professor of surgery at Stanford University, led this study that looked at triage patterns, or how patients were prioritized for injury treatment, among the elderly population.
The study included more than 6,000 patients over 55 years of age from California and Utah who were injured and admitted to a hospital between January 2006 and December 2007.
Patients were treated at various centers that were tied to the National Institutes of Health Clinical and Translational Science Award.
The researchers looked at trauma registry data, state-level discharge data, emergency department records and death files.
They tracked the number of patients who died within 60 days of being injured and compared the number of patients treated at trauma centers versus non-trauma centers.
Patients who were undertriaged were defined as those with an Injury Severity Score (ISS) of greater than 15 and who were taken to non-trauma center for treatment. The ISS is a scoring system on a scale of 1-75 for patients with more than one injury.
Scores between 16 to 24 are considered moderate to severe injuries and those higher than that are considered severe to critical injuries.
The researchers found that about 33 percent of the patients, or 80 patients total, were undertriaged. The higher rates of undertriage among the elderly population were tied to higher costs but not to higher death rates.
Median costs per-patient were $21,000 higher for severely injured patients taken to trauma centers than non-trauma centers.
In total, 244 patients had an injury severity score greater than 15. Overall, 17 percent of these patients died within a 60-day period.
Of the elderly patients treated at non-trauma centers, 9 percent died. In comparison, 5.7 percent of patients treated at trauma centers died.
The authors said that most of the deaths occurred not solely from the injuries. Patients' frailty and general health also contributed to their deaths.
"If trauma centers successfully improve outcomes in these patients, it may be that undertriage should be redefined to direct even minor injuries to trauma centers," the researchers wrote in their report.
The researchers also found that elderly patients taken to non-trauma centers were more often female and about nine years older on average compared to patients taken to trauma centers.
Patients treated at non-trauma centers also stayed a day longer than patients at trauma centers.
Adam Powell, PhD, president of Payer+Provider Syndicate and dailyRx Contributing Expert, said it is unsurprising that this study shows that it is more expensive to treat patients in a trauma center.
"When patients are treated in an advanced setting, costs tend to be higher," Dr. Powell told dailyRx. "It's far cheaper to build and maintain patient beds that only have a limited range of uses than it is to build and maintain highly-versatile beds."
The researchers noted a few limitations with their study. For one, the databases where they retrieved patient information might have had inconsistent records on diagnoses and complications.
The researchers also did not have information on patients' related illnesses, physiology and functional status.
According to the researchers, future research on the kinds of interventions that may be beneficial for the elderly population, including specialized geriatric hospitalist services, are needed.
In addition, the authors said that further study might look at how the findings apply to elderly patients who aren't as severely injured.
This study was published in the October issue of the Journal of the American College of Surgeons. No conflicts of interest were declared.
Funding for the study was provided by the Robert Wood Johnson Foundation Physician Faculty Scholars Program and the National Center for Research Resources under the National Institutes of Health.