The burden of geriatric traumatic brain injury on trauma systems: Analysis of 348,800 Medicare inpatient claims

作者：Samir M. Fakhry, Yan Shen, Jeneva M. Garland, Nina Y. Wilson, Ransom J. Wyse, Jennifer Morse, Darrell L. Hunt, David Acuna, James R. Dunne, Stanley Kurek, Stephanie Gordy, Dorraine D. Watts · 发表于：Journal of the American Geriatrics Society · 年份：2022 · DOI：10.1111/jgs.18114 · 被引用次数：15 · 研究领域：Trauma and Emergency Care Studies、Traumatic Brain Injury and Neurovascular Disturbances、Traumatic Brain Injury Research

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability in older adults. The aim of this study was to characterize the burden of TBI in older adults by describing demographics, care location, diagnoses, outcomes, and payments in this high-risk group. METHODS: Using 2016-2019 Centers for Medicare & Medicaid Services (CMS) Inpatient Standard Analytical Files (IPSAF), patients >65 years with TBI (>1 injury ICD-10 starting with "S06") were selected. Trauma center levels were linked to the IPSAF file via American Hospital Association Hospital Provider ID and fuzzy-string matching. Patient variables were compared across trauma center levels. RESULTS: Three hundred forty-eight thousand eight hundred inpatients (50.4% female; 87.1% white) from 2963 US hospitals were included. Level I/II trauma centers treated 66.9% of patients; non-trauma centers treated 21.5%. Overall inter-facility transfer rate was 19.2%; in Level I/II trauma centers transfers-in represented 23.3% of admissions. Significant TBI (Head AIS ≥3) was present in 70.0%. Most frequent diagnoses were subdural hemorrhage (56.6%) and subarachnoid hemorrhage (30.6%). Neurosurgical operations were performed in 10.9% of patients and operative rates were similar regardless of center level. Total unadjusted mortality for the sample was 13.9%, with a mortality of 8.1% for those who expired in-hospital, and an additional 5.8% for those discharged to hospice. Medicare payments totaled $4.91B, with the maj...