Mortality in the Elderly:  Comment on “Factors Associated With Trauma Center Use for Elderly Patients With Trauma”

Hsia and colleagues have undertaken an exhaustive retrospective analysis of patterns associated with trauma center (TC) use among the elderly in California over a span of a decade. The authors analyzed over 400 000 admissions and determined that increased age and likelihood of TC admission were inversely proportional. Furthermore, as patients aged beyond 65 years, the likelihood of TC admission declined even more. At first blush, one might assume this was due to the large proportion of hip fractures encountered in the elderly, but the authors wisely eliminated this diagnostic code from consideration when controlling for all variables; whether comparing blunt vs penetrating injuries, or mild vs moderate vs severe injuries, the elderly still had fewer TC admissions. Their data are certainly interesting and have public health implications far beyond trauma care, given the aging of our population.