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Elderly Injury: A Profile of Trauma Experience in the Sunshine (Retirement) State

Tepas, Joseph J. III MD; Veldenz, Henry C. MD; Lottenberg, Lawrence MD; Romig, Laurie A. MD; Pearman, Allen; Hamilton, Beth MSP; Slevinski, Richard S. MD; Villani, Dino J.

Journal of Trauma-Injury Infection & Critical Care: April 2000 - Volume 48 - Issue 4 - pp 581-586
Annual Meeting Articles

Objective: By using mandatory discharge data from a state agency, the records of 116,687 patients hospitalized for treatment of injury were evaluated to develop an epidemiologic and demographic profile of this population and to compare outcomes of patients treated in state-designated trauma centers (TC) with those treated in nontrauma centers (NTC).

Methods: Injury severity was calculated by using the International Classification Injury Severity Score methodology to compute individual diagnosis survival risk ratios from 698,187 reported diagnoses, and then by using these survival risk ratios to determine probability of survival for every patient. The population was then categorized by age, injury type, treatment facility designation, injury severity as indicated by probability of survival, and discharge disposition. Incidence of potentially preventable death was compared between TC and NTC, as was the effect on outcome of noninjury comorbidity.

Results: The average age of this population was 58 ± 26 years with significant skew toward the elderly in NTC (mean age, 62 ± 26 years). The most commonly encountered injuries likewise reflected the elderly nature of this population. Although 71.3% received care in NTC, the majority of severely injured were treated in TC. Potentially preventable mortality (>0.5) was significantly lower in TC. The effect of noninjury comorbidity on outcome was better managed by TC, both in terms of decreased mortality and in proportion of patients discharged home.

Conclusion: These data demonstrate the unique characteristics of injury victims treated in the state of Florida and indicate that the developing trauma system is demonstrating productivity in terms of avoidance of preventable death, efficient management of noninjury comorbid problems, and more complete recovery as indicated by proportion of patients discharged to home.

Stimulated by objective evidence of the need for improvement in care for the severely injured, the state of Florida has been developing its trauma system for most of the past 2 decades. 1,2 There have been many attempts to expand system coverage, regulate quality of care, and remunerate hospitals that achieve recognition as state-designated trauma centers. Despite this enthusiastic conceptual support, some rural and metropolitan populations remain without access to organized trauma care. Moreover, the financial stresses of the current health care environment and the propagation of interhospital alliances are forcing existing trauma centers to revisit the fiscal viability of their trauma-related missions.

The effect of this situation is a fragmented system of trauma care in which designated institutions practice state of the art care under continuous scrutiny of the State Department of Health, and nondesignated institutions do what they can to provide care to those patients who are transported to them. Field triage is governed by a “scorecard” methodology that is easily subverted and almost impossible to enforce. 3 Interhospital transfer is completely unregulated and is frequently influenced by imperatives of managed care or hospital alliance. Three highly publicized trauma triage misadventures related to the latter problem stimulated members of the 1998 Florida Legislature to appropriate funds to the Department of Health to study the function of the state’s trauma system and to report to it recommendations for improvement. This report is an analysis of the data made available for that evaluation and describes the results of care for every patient admitted to an acute care hospital for treatment of any injury during 1996.

From the University of Florida Health Sciences Center, Division of Pediatric Surgery, Jacksonville, Florida.

Address for reprints: J. J. Tepas, MD, the University of Florida Health Sciences Center, Division of Pediatric Surgery, 655 W. 8th Street, Jacksonville, FL 32209.

Submitted for publication September 24, 1999.

Accepted for publication December 30, 1999.

Presented at the 59th Annual Meeting of the American Association for the Surgery of Trauma, September 16–18, 1999, Boston, Massachusetts.

© 2000 Lippincott Williams & Wilkins, Inc.