Pre- and in-hospital time management in the elderly trauma patients: A retrospective analysis

Abstract text (incl. references and figure legends)

Introduction: Trauma to the elderly age segment accounts for an increasing proportion of admissions to trauma centers. Despite the well-known increased risk for morbidity and mortality of elderly compared to younger patients, disparities in the care of geriatric trauma patients have been documented in multiple studies. The aim of our study was to analyze the differences in time management in the pre- and in-hospital setting of elderly compared to younger patients.

Material & Methods: Retrospective analysis of all trauma patients primarily admitted to our shock room from 01/2015 to 07/2022. Demographics, clinical and physiological parameters, and time intervals in the pre- and early in-hospital period were compared between elderly (≥65 years) and younger (<65 years) patients.

Results: A total of 972 patients (elderly, n=326) were included in this study. Compared to the younger population, elderly patients presented with significantly higher ISS (20.5 ± 10.6 vs. 14.3 ± 12.0; p<0.001) and a lower GCS score (10.2 ± 4.8 vs. 12.6 ± 4.2; p<0.001). After controlling for injury characteristics and pre-hospital procedures, geriatric patients experienced significantly longer pre-hospital scene times compared to their younger counterparts (48.8 ± 18.0 vs. 43.9 ± 17.6 minutes; p<0.001). In-hospital time management, however, did not show any statistical significant differences between the two groups (Time from shock room admission until FAST examination: elderly 7.6 ± 7.3 vs. younger patients 7.1 ± 8.6 minutes; p=0.36. Time from admission until whole-body CT scan: 29.4 ± 22.0 vs. 28.1 ± 15.5 minutes; p=0.39).

Conclusions: Despite being more severely injured, elderly patients experience longer pre-hospital scene times compared to younger patients. However, no time differences between the groups were found in the early in-hospital setting. Reasons for this disparity in pre-hospital times may include delayed recognition of injury severity in the elderly trauma population.

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