Interhospital transfers in elderly trauma patients

Malte Andreas Groth-Rasmussen Koch; Tobias Arleth; Oscar Rosenkrantz; Søren Steemann Rudolph; Jacob Steinmetz

doi:10.1016/j.injury.2024.111998

Interhospital transfers in elderly trauma patients

Injury. 2024 Oct 31:111998. doi: 10.1016/j.injury.2024.111998. Online ahead of print.

Authors

Malte Andreas Groth-Rasmussen Koch¹, Tobias Arleth², Oscar Rosenkrantz³, Søren Steemann Rudolph², Jacob Steinmetz⁴

Affiliations

¹ Department of Anesthesia, Center of Head, Orthopedics and Trauma Center, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 3B, 2200 København N, Denmark. Electronic address: Malte.Andreas.Groth-Rasmussen.Koch@regionh.dk.
² Department of Anesthesia, Center of Head, Orthopedics and Trauma Center, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark.
³ Department of Anesthesia, Center of Head, Orthopedics and Trauma Center, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43-45, Aarhus, 8200 Aarhus N, Denmark.
⁴ Department of Anesthesia, Center of Head, Orthopedics and Trauma Center, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 3B, 33.5, Sektion A, 2200 København N, Denmark; Danish Air Ambulance, Aarhus, Denmark. Brendstrupgårdsvej 7, 2. th, 8200 Aarhus N, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark.

PMID: 39550344
DOI: 10.1016/j.injury.2024.111998

Abstract

Introduction: The elderly population is growing worldwide and is more likely to die from injuries that younger patients would likely survive. Furthermore, elderly trauma patients are often subjected to triage decisions that admit them to lower-level facilities. These patients may require interhospital transfer to a major trauma center for definitive care. The aim of this study was to investigate the time interval from arrival at the primary hospital to arrival at the trauma center among elderly trauma patients (≥65 years) as compared to younger, adult patients (18-64 years). We hypothesized that elderly trauma patients would endure a longer time interval.

Methods: This was a retrospective quality assurance study based on patient data in our trauma registry at the Trauma Center of Copenhagen University Hospital, Rigshospitalet in Denmark. Data were extracted in the period between 2018 and 2023. We included all adult trauma patients (≥18 years) who underwent interhospital transfer to the trauma center. The primary outcome was minutes from arrival at the primary hospital to arrival at the trauma center. A quality standard of at least 90 % of patients arriving at the trauma center in <240 min after arrival at the primary hospital, was chosen.

Results: In total, 565 patients were included and divided into an elderly cohort (n = 184) and a younger cohort (n = 381). The elderly cohort had a significantly longer median delay (247 vs. 197 min; estimated difference 50 min, 95 % confidence interval (CI) [28, 71]; p < 0.001). The elderly cohort met the quality standard less than the younger cohort (49 % vs. 68 %). The elderly cohort had a significantly higher injury severity score (17 [IQR 13, 25] vs. 16 [IQR 9, 21]; p < 0.001), and we found a significant difference in 30-day mortality, which was supported by an adjusted odds ratio of 6.35 (95 % CI [2.84, 15.7]; p < 0.001).

Conclusions: In conclusion, elderly trauma patients experienced significantly longer median delays from arrival at the primary hospital to arrival at the trauma center compared to younger adult trauma patients. The elderly trauma patients met the quality standard for transfer time at a lower rate than the younger group.

Keywords: Delay; Elderly; Interhospital transfer; Trauma.