AHRQ Study: Trauma Registries Ineffective Data Sources for Evaluating Care of Injured Older Adults

Nearly 80 percent of registry-eligible serious injuries among adults age 65 years or older were not recorded in two state trauma registries commonly used for evaluating and improving patient care, according to a new AHRQ-funded study published in the July issue of JAMA Surgery. Researchers examined the medical records for 51 medical centers in Washington and Oregon during 2011. They identified 8,161 older patients with serious injuries that required surgery or resulted in death, qualifying them for recording in trauma registries. However, only 1,720 of these patients, or 21 percent, had a matching trauma registry record. Researchers discovered that registries missed 93 of 188 in-hospital deaths and 178 of 553 major eligible injuries. In addition, 81 percent of all deaths after injury (1,531 of 1,887 cases) were not recorded in the registry. Researchers concluded that trauma registries are failing to effectively capture, track and evaluate older injured patients. Access the abstract.

2019 Jul 10:e192279. doi: 10.1001/jamasurg.2019.2279. [Epub ahead of print]

Comparison of Injured Older Adults Included in vs Excluded From Trauma Registries With 1-Year Follow-up.

Newgard CD1, Caughey A2, McConnell KJ1,3, Lin A1, Eckstrom E4, Griffiths D1, Malveau S1, Bulger E5.

Author information

1: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland.
2: Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland.
3: Center for Health Systems Effectiveness, Department of Emergency Medicine, Oregon Health & Science University, Portland.
4: Division of Geriatrics, Department of Internal Medicine, Oregon Health & Science University, Portland.
5: Department of Surgery, University of Washington, Seattle.

Abstract

IMPORTANCE:

Trauma registries are the primary data mechanism in trauma systems to evaluate and improve the care of injured patients. Research has suggested that trauma registries may miss high-risk older adults, who commonly experience morbidity and mortality after injury.

OBJECTIVE:

To compare injured older adults who were included in with those excluded from trauma registries, with a focus on patients with serious injuries, requiring major surgery, or dying after injury.

DESIGN, SETTING, AND PARTICIPANTS:

This cohort study included all injured adults 65 years and older transported by 44 emergency medical services agencies to 51 trauma and nontrauma centers in 7 counties in Oregon and Washington from January 1, 2011, to December 31, 2011, with follow-up through December 31, 2012. Record linkage was used to match emergency medical services records with state trauma registries, state discharge databases, state death registries, and Medicare claims. Data were analyzed from August to November 2018.

EXPOSURES:

Inclusion in vs exclusion from a trauma registry.

MAIN OUTCOMES AND MEASURES:

Mortality up to 12 months, including time to death and causes of death.

RESULTS:

Of 8161 included patients, 5579 (68.4%) were women, and the mean (SE) age was 82.2 (0.10) years. A total of 1720 older adults (21.1%) were matched to a trauma registry record. Seriously injured patients not captured by trauma registries ranged from 18% (7 of 38 patients with abdominal-pelvic Abbreviated Injury Scale score of 3 or greater) to 80.0% (1792 of 2241 patients with extremity Abbreviated Injury Scale score of 3 or greater), while 68 of 186 patients requiring major nonorthopedic surgery (36.6%) and 1809 of 2325 patients requiring orthopedic surgery (77.8%) were not included in trauma registries. Of patients with serious injuries or undergoing major surgery missed by trauma registries (range by injury and procedure type, 36.0% to 57.1%), 36.4% (39.3% when excluding serious extremity injuries and orthopedic procedures) were treated at trauma centers, particularly level III through V hospitals. When registry and nonregistry groups were tracked over 12 months, 93 of 188 in-hospital deaths (49.5%) and 1531 of 1887 total deaths (81.1%) occurred in the nonregistry cohort.

CONCLUSIONS AND RELEVANCE:

In their current form, trauma registries are ineffective in capturing, tracking, and evaluating injured older adults, although mortality following injury is frequently due to noninjury causes. High-risk injured older adults are not included in registries because of care in nontrauma hospitals, restrictive registry inclusion criteria, and being missed by registries in trauma centers.