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Age-related trends in severe injury hospitalization in Canada

Hill, Andrea D. PhD; Pinto, Ruxandra PhD; Nathens, Avery B. MD, PhD; Fowler, Robert A. MD, MS

Journal of Trauma and Acute Care Surgery: October 2014 - Volume 77 - Issue 4 - p 608–613
doi: 10.1097/TA.0000000000000412
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BACKGROUND We performed a population-based evaluation of age-related trends in severe injury hospitalization across Canada.

METHODS We identified hospitalizations following severe injury (Injury Severity Score [ISS] > 15) between 2002 and 2009 using the Canadian National Trauma Registry. Age-standardized severe injury hospitalization rates were calculated using the direct method referencing the 2006 Canadian population. The annual percent change in hospitalization rates were estimated using negative binomial regression.

RESULTS During the 8-year period, hospitalization rates for severe injury rose by 22% among individuals 65 years or older, compared with 10% among individuals younger than 65 years. Fall-related injuries accounted for 46% of all severe injury hospitalizations and increased by an average of 3% annually, with a twofold higher annual rate of increase among the elderly. Case-fatality rates declined by 10%, with the decline more than threefold higher among younger patients.

CONCLUSION Elderly patients accounted for an increasing proportion of hospitalizations, highlighting important opportunities for injury prevention among this age group. Case-fatality rates, while declining among younger patients, remained stable in the elderly population, suggesting the need for better strategies to manage the complex care needs of these patients.

LEVEL OF EVIDENCE Epidemiologic study, level III.

Supplemental digital content is available in the text.

From Sunnybrook Research Institute (A.D.H., A.B.N., R.A.F.); Departments of Critical Care (A.D.H., R.A.F., R.P.), and Surgery (A.B.N.), Sunnybrook Health Sciences Centre; Clinical Epidemiology Program (R.A.F., A.B.N.), Institute of Health Policy, Management and Evaluation, and Interdepartmental Division of Critical Care (R.A.F.), and Keenan Research Centre of the Li Ka Shing Knowledge Institute (A.B.N), St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada.

Submitted: February 13, 2014, Revised: June 25, 2014, Accepted: July 11, 2014.

Material related to this paper was presented at the Trauma Association of Canada Annual Scientific Meeting, April 7–8, 2011, in Banff, Alberta, Canada.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Andrea D. Hill, PhD, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada, M4N 3 M5; email: Andrea.Hill@sunnybrook.ca.

© 2014 Lippincott Williams & Wilkins, Inc.