Comparison of survival outcomes among older adults with major trauma after trauma center versus non‐trauma center care in the United States

OBJECTIVE: To compare level 1 and 2 trauma centers with similarly sized non‐trauma centers on survival after major trauma among older adults. DATA SOURCES AND STUDY SETTING: We used claims of 100% of 2012–2017 Medicare fee‐for‐service beneficiaries who received hospital care after major trauma. STUDY DESIGN: Survival differences were estimated after applying propensity‐score‐based overlap weights. Subgroup analyses were performed for ambulance‐transported patients and by external cause. We assessed the roles of prehospital care, hospital quality, and volume. DATA COLLECTION: Data were obtained from the Centers for Medicare and Medicaid Services. PRINCIPAL FINDINGS: Thirty‐day mortality was higher overall at level 1 versus non‐trauma centers by 2.2 (95% confidence interval [CI]: 1.8, 2.6) percentage points (pp). Thirty‐day mortality was higher at level 1 versus non‐trauma centers by 2.3 (95% CI: 1.9, 2.8) pp for falls and 2.3 (95% CI: 0.2, 4.4) pp for motor vehicle crashes. Differences persisted at 1 year. Level 1 and 2 trauma centers had similar outcomes. Hospital quality and volume did not explain these differences. In the ambulance‐transported subgroup, after adjusting for prehospital variables, no statistically significant differences remained. CONCLUSIONS: Trauma centers may not provide longer survival than similarly sized non‐trauma hospitals for severely injured older adults.