Predictors of Severe Sepsis and Septic Shock in Geriatric Trauma Patients: The Role of Hospital Characteristics

Author(s):
Manuel Castillo-Angeles ; Christine Wu; Rebecca Wiener; Stephanie Nitzschke; Reza Askari MD

Background:

The incidence of severe sepsis and septic shock have been increasing in recent years. Even though these occur infrequently in the geriatric trauma population, they are associated with worse outcomes, most importantly increased mortality. The purpose of this study was to identify predictors of severe sepsis/septic shock in this population and to determine if hospitals characteristics play an important role.

Hypothesis:

We hypothesize that hospital characteristics, particularly trauma center designation, are significantly associated to the development of severe sepsis/septic shock in injured older adults.

Methods:

This was a retrospective analysis of Medicare inpatient claims from 2014 to 2015 that included patients (65 years or older) with a primary diagnosis of traumatic injury. Severe sepsis/septic shock was identified by ICD-9-CM diagnosis codes 785.52 and 995.92. Demographic and clinical characteristics were collected. Hospital characteristics included trauma center designation (Level I, II, and non-trauma center), teaching status (teaching vs non-teaching), hospital bed size (<200 vs ³200 beds), and trauma volume in each hospital. Multivariate logistic regression analysis was performed to identify the association between patient- and hospital-level variables and sepsis/septic shock.

Results:

We included 772,109 geriatric trauma patients. Mean age was 82.15 (SD 8.49), 68.28% were female and 91.61% were white. 12,240 (1.59%) had severe sepsis/septic shock. After adjusted analysis, Black race (Odds Ratio [OR] 1.44, 95% Confidence Interval [CI] 1.04 – 2.00), Charlson Comorbidity Index (OR 1.23, 95% CI 1.18 – 1.27), and Injury Severity Score (OR 1.05, 95% CI 1.04 – 1.06) were associated with a higher likelihood of having severe sepsis/septic shock. Care at a non-trauma center (OR 0.65, 95% CI 0.52 – 0.81) and trauma volume (OR 0.98, 95% CI 0.98 – 0.99) were associated with a lower likelihood of having severe sepsis/septic shock.

Conclusions:

This study shows that trauma volume and trauma center designation were significant predictors of severe sepsis/septic shock in injured older adults. Further work is needed to identify geriatric-centered strategies that could be implemented at a hospital-level to decrease the rates of severe sepsis/septic shock.