Should we redefine the age of geriatric trauma? An insight from American College of Surgeons Trauma Quality Improvement Program database 30-day mortality risk.

Background: Older injured patients have higher mortality compared with their younger counterparts, and their outcomes worsen with each decade of life. However, the exact age to classify a patient as "geriatric" is not universally defined. Identifying an evidence-based age cutoff for "geriatric" trauma activations is important to preserve hospital and human resources by not superfluously including younger patients but also not depriving older high-risk patients of resources needed to achieve their best recovery. The aim for our study is to define changes in mortality by age to determine the age at which patients are at risk of worse outcomes and should be classified as "geriatric."

Methods: This is a retrospective study of the American College of Surgeons Trauma Quality Improvement Program database. We obtained patients who had ground level fall (GLF) and sampling of patients with all trauma mechanism between the age of 17 and 89 years. Binary segmentation change-point analysis was used to calculate the optimized number and position of change points in mean unadjusted mortality by age for both GLF and all trauma groups.

Results: A total of 1,360,160 GLF patients from the 2013-2021 American College of Surgeons Trauma Quality Improvement Program database were included. The random sample of all-trauma patients included 1,332,072 patients. Binary segmentation change-point analysis indicated that change point in mean unadjusted mortality occurs at 72 years of age for all trauma and 65 years of age for GLFs. All-trauma patients older than 72 years had an over four times increased odds of mortality, while GLF patients older than 65 years have a threefold increase in mortality compared with patients below those cutoffs.

Discussion: We find that, for the elderly, mortality increases at different change points for all-trauma and GLF patients (72 and 65 years of age, respectively). Based on this finding, further study should be done using these two different age cutoff points based on mechanism of injury to mitigate mortality in geriatric trauma patients.

Level of evidence: Prognostic and Epidemiologic Study; Level III.