• Howard Nelson-Williams, Lisa Kodadek, Joseph Canner, Eric Schneider, David Efron, Elliott Haut, Babar Shafiq, Adil Haider, and Catherine Garrison Velopulos.
• Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, Maryland.
• J. Surg. Res. 2015 Oct 1; 198 (2): 468-74.

BackgroundYounger, multi-trauma patients have improved survival when treated at a trauma center. Many regions now propose that older patients be triaged to a higher level trauma centers (HLTCs-level I or II) versus lower level trauma centers (LLTCs-level III or nondesignated TC), even for isolated injury, despite the absence of an established benefit in this elderly cohort. We therefore sought to determine if older isolated hip fracture patients have improved survival outcomes based on trauma center level.MethodsA retrospective cohort of 1.07 million patients in The Nationwide Emergency Department Sample from 2006-2010 was used to identify 239,288 isolated hip fracture patients aged ≥65 y. Multivariable logistic regression was performed controlling for patient- and hospital-level variables. The main outcome measures were inhospital mortality and discharge disposition.ResultsUnadjusted logistic regression analyses revealed 8% higher odds of mortality (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.00-1.16) and 10% lower odds of being discharged home (OR, 0.90; 95% CI, 0.80-1.00) among patients admitted to an HLTC versus LLTC. After controlling for patient- and hospital-level factors, neither the odds of mortality (OR, 1.06; 95% CI, 0.97-1.15) nor the odds of discharge to home (OR, 0.98; 95% CI, 0.85-1.12) differed significantly between patients treated at an HLTC versus LLTC.ConclusionsAmong patients with isolated hip fractures admitted to HLTCs, mortality and discharge disposition do not differ from similar patients admitted to LLTCs. These findings have important implications for trauma systems and triage protocols.Copyright © 2015 Elsevier Inc. All rights reserved.

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