Are Older Adults With Hip Fractures Disadvantaged in Level 1 Trauma Centers
Dados Bibliográficos
| ID | 9104330 |
|---|---|
| Autores | David Metcalfe (0000-0003-1008-3105, Harvard Medical School, autor correspondente), Olubode A Olufajo (0000-0002-1565-538X, Harvard Medical School, autor correspondente), Cheryl K Zogg (0000-0003-4461-746X, Harvard Medical School, autor correspondente), Jonathan D Gates (0000-0002-3554-090X, Brigham & Women’s Hospital, Boston, MA), Michael J Weaver (0000-0003-1062-8144, Brigham & Women’s Hospital, Boston, MA), Mitchel B Harris (0000-0001-7003-6138, Brigham & Women’s Hospital, Boston, MA), Arturo J Rios-Diaz (0000-0002-0867-1920, Harvard Medical School, autor correspondente), Adil H Haider (0000-0003-0101-5573, Harvard Medical School, autor correspondente), Ali Salim (0000-0002-4719-0505, Harvard Medical School, autor correspondente) |
| Ano | 2016 |
| Volume | 54 |
| Fascículo | 6 |
| Páginas | 616-622 |
| Data de publicação | 2016-06-01 |
| Peer Reviewed | Sim |
| Open Access | Não |
| Tipo | ARTICLE |
| Periódico | Medical Care (JOURNAL) |
| Identificadores do periódico | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Editora | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000535 |
| PMID | 26974676 |
| OpenAlex | W2299808858 |
| Idioma | EN |
| Referências citadas | 30 |
BACKGROUND: Large regional hospitals achieve good outcomes for patients with complex conditions. However, recent studies have suggested that some patient groups might not benefit from treatment in higher-level trauma centers. OBJECTIVE: To test the hypothesis that older adults with isolated hip fractures experience delayed surgical treatment and worse clinical outcomes when treated in higher-level trauma centers. RESEARCH DESIGN: Retrospective cohort study using a statewide longitudinal database that captured 98% of inpatients within California (2007-2011). SUBJECTS: All older adults (aged 65 y and above) admitted with an isolated hip fracture who did not require interhospital transfer. MEASURES: Days to operation, length of stay, inhospital mortality, 30-day risk of unplanned readmission, 30-day venous thromboembolism, decubitus ulcers, and pneumonia. RESULTS: There were 91,401 patients, 6.1% of whom were treated in a level 1 trauma center (L1TC), 17.7% in a level 2 trauma center (L2TC), and 70.2% in a nontrauma center (NTC). Within multivariable logistic and generalized linear regression models, patients treated in L1TCs underwent surgery later (predicted mean difference: 0.30 d; 95% CI, 0.08-0.53), had prolonged inpatient stays (0.99 d, 0.40-1.59), and had higher odds of both 30-day readmission (aOR=1.62; 95% CI, 1.35-1.93) and venous thromboembolism (aOR=1.32, 1.01-1.74) relative to NTCs. There were no differences in mortality, decubitus ulcers, or pneumonias. L2TCs were not different from NTCs across any of the measured outcomes. CONCLUSIONS: Older adults with hip fractures may be disadvantaged in L1TCs. Further research should aim to develop our understanding of this disparity to ensure that all patient groups benefit from the resources and expertise available within these hospitals
Cohort study · Hip fracture · Injury prevention · Injury Severity Score · Logistic regression · Odds ratio · Osteoporosis · Pneumonia · Poison control · Retrospective cohort study · Trauma center · Emergency Medicine · Hip and Femur Fractures · Internal Medicine · Medicine · Total Knee Arthroplasty Outcomes · Trauma and Emergency Care Studies
| Velocidade de citação | historical |
|---|---|
| Altamente citado | Não |