The Public Health Burden of Geriatric Trauma: Analysis of 2,688,008 Hospitalizations from CMS Inpatient Claims


South Atlantic


Grand Strand Medical Center

Document Type


Publication Date



trauma, aged, wounds and injuries, hospitalization


Geriatrics | Public Health | Surgery | Trauma


BACKGROUND: Geriatric trauma care (GTC) represents an increasing proportion of injury care, but associated public health research on outcomes and expenditures is limited. The purpose of this study was to describe GTC characteristics, location, diagnoses, and expenditures.

METHODS: Patients at short-term, non-federal hospitals aged ≥65 with ≥1 injury ICD-10 were selected from 2016-19 CMS Inpatient Standard Analytical Files (IPSAF). Trauma center levels were linked to IPSAF files via AHA Hospital ID and fuzzy string matching. Demographics, care location, diagnoses, and expenditures were compared across groups.

RESULTS: 2 688 008 hospitalizations (62% female; 90% white; 71% falls, mean ISS 6.5) from 3286 hospitals were included, comprising 8.5% of all Medicare inpatient hospitalizations. Level I centers encompassed 7.2% of the institutions (n = 236) but 21.2% of hospitalizations, while non-trauma centers represented 58.5% of institutions (n = 1923) and 37.7% of hospitalizations. Compared to non-trauma centers, patients at Level I centers had higher Elixhauser scores (9.0 vs 8.8]) and ISS (7.4 vs 6.0; P < .0001). The most frequent primary diagnosis at all centers was hip/femur fracture (28.3%), followed by TBI (10.1%). Expenditures totaled $32.9B for trauma-related hospitalizations, or 9.1% of total Medicare hospitalization expenditures and ~ 1.1% of the annual Medicare budget. The overall mortality rate was 3.5%.

CONCLUSIONS: GTC accounts for 8.5% of all inpatient GTC and a similar percentage of expenditures, the most common injury being hip/femur fractures. The largest proportion of GTC occurs at non-trauma centers, emphasizing their vital role in trauma care. Public health prevention programs and GTC guidelines should be implemented by all hospitals, not just trauma centers. Further research is required to determine the optimal role of trauma systems in GTC, establish data-driven triage guidelines, and define the impact of trauma centers and non-trauma centers on GTC mortality.

LEVEL OF EVIDENCE: Level II (therapeutic/care management).

Publisher or Conference

The Journal of Trauma and Acute Care Surgery