Background: The purpose of the study was to evaluate whether the higher level of care significantly affected the outcomes of elderly patients who fell from ground level at home and had a normal physiological examination at the scene.
Methods: Patients 65 years and older, with normal physiological measures at the scene (Glasgow Coma Scale score = 15, systolic blood pressure > 90 and <160 mm Hg, heart rate (HR) ≥ 60 and ≤100) from the 2012 to 2014 National Trauma Data Bank data sets were included in the study. Patients' characteristics, existing comorbidities, and outcomes were compared between Level I or Level II designated trauma centers (higher level care [group 1]) and Levels III, IV, and unranked/nontrauma centers (lower level care [group 2]). Following initial analyses, propensity score matching was performed, and the rate of in-hospital mortality, median time (days) to death or discharge, and discharge disposition were compared.
Results: Of the 40,800 patients who met inclusion criteria, 18,813 patients were matched from each group on age, sex, race, systolic blood pressure, HR, respiratory rate, Injury Severity Score, and comorbidity statuses. There was no evidence of a significant difference regarding in-hospital mortality (2.5% vs. 2.3%), time to death (median [interquartile range]: 6 [3-11] vs. 6 [3-11]), or time to hospital discharge (median [interquartile range]: 5 [5-5] vs. 5 [5-5]). However, the rate of required postdischarge care (78.9% vs. 81.7%) varied significantly between the groups.
Conclusion: Higher levels of care failed to show any significant survival benefits or shorten the time to hospital discharge; however, a significantly higher proportion of patients from lesser-care facilities required follow-up services after discharge.
Level of evidence: Therapeutic/Care management, level IV.
Study type: Observational case-control.