A population-based study of geriatric trauma in a rural state

Background: Urban geriatric trauma patients are known to die more often tha n their younger counterparts. Little is known of the fate of geriatric trau ma patients in a rural environment where delays to definitive treatment are frequent. We hypothesized that rural trauma patients would do worse than t heir urban counterparts because of prolonged delays to definitive care. Methods: Five-year retrospective analysis of all trauma deaths occurring wi thin a rural state and retrospective outcome analysis of trauma patients ad mitted to a tertiary care facility who were less than 55 years old (defined as young) and 55 or more years old (defined as old). Outcome analysis was performed comparing old and young rural hospitalized patients to the Major Trauma Outcome Study data set collected hi major urban trauma centers. Results: Of the total trauma deaths in the state, 32.5% were old Old patien ts were less likely to die at the scene of the injury than sere their young er counterparts (R-2 = 0.84 p < 0.001). Hospitalized old patients had a sig nificantly higher mean Revised Trauma Score and a significantly lower Injur y Severity Store, a higher complication rate, and a higher mortality rate t han did hospitalized young patients. The young group had a significantly be tter survival (W = 0.59, Z = -3.49, p = 0.0001) than the MTOS data set, but the old group had a significantly worse survival (W = --1.8, Z = -3.49, p = 0.001), Conclusion: In a rural environment, old trauma patients die more commonly i n the Hospital than their younger counterparts, who die more commonly at th e scene, Old trauma patients who die in the hospital were less severely inj ured than their younger counterparts who died in the hospital. Old patients admitted to this rural trauma center have a significantly worse survival t han their urban counterparts despite the fact that young rural trauma patie nts do significantly better than their urban counterparts. Understanding th e demographics of rural geriatric trauma may be useful in allocating resour ces in rural trauma system design. It must be understood that despite relat ively low injury severity and physiologic stability, there is a significant potential for rural geriatric trauma patients to do poorly.