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NESS 2006 Annual Meeting
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Time to Definitive Care is Prolonged in Elderly Trauma Patients
Bernard J Benedetto, Walter L Biffl, David T Harrington, Hieu Ton-That, Charles A Adams, William G Cioffi
Rhode Island Hospital, Providence, RI

Objective: Previous work has demonstrated that prolonged time to definitive care (TTC - time at outside hospitals and in transit prior to arrival at Trauma Center) is associated with poor outcomes. Elderly patients (>65 years old) represent the most rapidly expanding segment of the trauma population and suffer worse outcomes. Given this, we hypothesized that elderly patients may be particularly susceptible to prolonged TTC. We sought to examine the impact of prolonged TTC and age on outcomes in this population.
Design: Retrospective review of a prospectively maintained trauma registry.
Setting: Level 1 Trauma Center.
Patients: Adult trauma transfer patients admitted between 1/1/00 and 12/31/04. Patients with head injury (GCS<13) were excluded.
Main Outcome Measures: TTC and in-hospital mortality.
Results: 959 patients were admitted with a mean injury severity score (ISS) of 11.7 and a mean TTC of 268 minutes. Overall mortality was 3.3%. 306 (32%) of patients were elderly. Elderly patients had prolonged TTC (296 minutes vs. 248 minutes, p<0.05) despite similar ISS (13.1 vs. 11.0, p=ns). Mortality in the elderly group was higher (6.7% vs 1.2%, p<0.05). Mortality was higher in the in the prolonged TTC group - 0% mortality for a TTC <120 minutes (ISS 15.5) and 11.4% mortality for a TTC between 120-300 minutes (ISS 13.3).
Conclusions: Elderly trauma patients have longer TTC than younger trauma patients despite similar ISS. Mortality in the elderly group increased with prolonged TTC. No elderly patient with a TTC <120 minutes died. Expediting transfer to definitive care appears to be an important factor in improving the survival of elderly trauma patients. This should be a focus of educational efforts and management protocols within a Trauma System.

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