Analysis of prognosis and medical resource utilization in elderly patients with trauma: A retrospective cohort study in one trauma center

Abstract

Background:

Trauma is consistently among the top 10 causes of death worldwide. The aging population, constituting 15.21% of adults aged over 65 in Taiwan as of November 2019, has significantly impacted healthcare expenditures. This study aimed to explore the prognosis and resource utilization in patients with geriatric trauma.

Methods:

This retrospective analysis included emergency room admissions between January 2015 and December 2017 at a level I trauma center in southern Taiwan. Comparisons between the age groups assessed medical resource use, patient characteristics, trauma profiles, and management. Outcomes examined included mortality, complications, length of hospital stay (LOS), duration of intensive care unit (ICU) stay, and costs.

Results:

Of the 5185 eligible patients, 1743 were elderly. Elderly patients, predominantly women, exhibit more blunt injuries often resulting from accidental falls. They experienced longer hospital stays and higher medical expenses, as well as increased complication and mortality rates. Mortality predictors included age, Glasgow Coma Scale (GCS) score, trauma severity score (≥16), complications, surgery, and initial hypotension.

Conclusion:

Elderly patients experienced longer LOS, higher mortality and complication rates, and greater total medical costs compared to younger individuals. These findings highlight the increased healthcare resource utilization and heightened mortality risks faced by elderly trauma patients. Thus, tailored healthcare approaches and resource allocation strategies are essential to meet the needs of this aging population in trauma care.

Lay Summary: This study analyzed trauma registry data in Taiwan and found that patients aged 65 years or older had more complications, longer hospital stays, higher medical costs, and a greater risk of death compared with younger patients. Poor outcomes were associated with severe injury, low blood pressure, and reduced consciousness at hospital arrival. Patients who received surgery showed better survival. These findings suggest that geriatric trauma patients require tailored care strategies and appropriate allocation of healthcare resources to improve outcomes and reduce medical costs.

1. INTRODUCTION

Globally, trauma consistently ranks among the top 10 causes of death. In Taiwan, it is one of the top 10 causes of death. Trauma exhibits distinct characteristics; generally, aside from fire incidents, males have a higher injury rate than females. In Taiwan, most trauma results from blunt-force mechanisms. Elderly individuals generally have a worse prognosis than younger individuals after injury.¹ Generally, elderly individuals have lower residual organ function and higher comorbidity rates, and their injuries are often underestimated.² According to the 2016 National Health Insurance medical statistics from the Health Insurance Administration, healthcare expenses for patients over 65 years of age accounted for 36.2% of the total expenditure, amounting to approximately 224.2 billion New Taiwan Dollars.³ According to Chen,⁴ healthcare expenses for the elderly in Taiwan are projected to significantly increase across various models due to substantial growth in the elderly population. Over the past 20 years, the elderly population in Taiwan (aged >65 years) has doubled.⁵ This rising trend in the elderly population will significantly impact healthcare resource utilization, influencing future policy formulation and the allocation of public healthcare resources. Further exploration is necessary to understand the utilization of healthcare resources by elderly patients with trauma. Age can influence the utilization of trauma healthcare resources, suggesting the need for distinct benefit standards for various age groups.⁶ This study investigated the prognosis of elderly patients with trauma and analyzed their healthcare resource utilization.

2. METHODS

This study analyzed trauma registry data from a medical center in southern Taiwan, covering the period from January 1, 2015 to December 31, 2017. The hospital has approximately 1300 beds and a staff of around 2600, which includes approximately 300 attending physicians. Data were collected retrospectively from the hospital’s trauma registry database. The study period spanned from January 2015 to December 2017 and included 6246 hospitalized patients after initial trauma management. After excluding cases with missing data and patients under 18 years old, 5185 patients remained. Among them, 1743 were elderly (aged 65 years and above), with the elderly and super-elderly distinguished by an age cutoff of 80 years. Elderly individuals were the primary participants in this study. We obtained approval from the institutional review board (IRB) approval for data access. The application specifies the data used for the statistical analysis and research purposes.

The characteristics between young and elderly patients were compared. The relationships between different age categories and the characteristics and resource utilization of trauma patients were analyzed using t tests and chi-squared tests. The mortality rates and influencing factors for the elderly and super-elderly were analyzed using a one-way analysis of variance (ANOVA). The relationships between mortality and age, trauma score, intensive care unit (ICU) length of stay, total length of hospital stay (LOS), and total costs were analyzed using binary logistic regression. The impacts of different factors on mortality were analyzed using the chi-square test. The impact of various factors on costs was analyzed using t tests. A single-factor logistic regression analysis was performed. Logistic regression was used for the multivariate analysis to explore the relationship between factors, with statistically significant differences identified in the single-factor analyses.

The statistical software used in this study was IBM SPSS Statistics 24.

3. RESULTS

We found that the average age of elderly patients aged over 65 was 78.09 years. Among the elderly patients, there were 825 (47.50%) males and 915 (53.50%) females. The average age of the patients under 65 was 39.32 years. Among the younger patients, there were 2188 (63.57%) males and 1254 (36.43%) females. There was a higher proportion of females among the elderly patients, whereas males predominated among the younger patients.

Considering admission methods, 617 (35.40%) were elderly patients who were self-referred, 622 (35.69%) were brought in by emergency medical services (EMS), and 504 (28.91%) were transferred from other hospitals. In contrast, 1131 (32.86%) younger patients were self-referred, 1391 (40.41%) were brought in by EMS, and 920 (26.73%) were transferred from other hospitals. Elderly individuals had a lower proportion of admissions to EMS than younger individuals.

Concerning the rate of major trauma (Injury Severity Score [ISS] ≥16) in the two groups, there were a total of 197 elderly patients (11.54%) and 411 younger patients (11.91%). There were no statistically significant differences between the two groups. The average total hospital stay for elderly patients was 9.36 days, compared to 7.86 days for younger patients. Elderly individuals had longer hospital stay than younger individuals (p < 0.001). The average stay in the ICU for elderly patients was 6.61 days, whereas it was slightly lower for younger patients at 5.54 days, although the difference was not statistically significant.

The average total cost per person was higher for elderly patients (NTD 122918.01) than NTD 114018.91 for younger patients, although this difference was not statistically significant. However, when considering health insurance expenditures, elderly individuals had significantly higher costs at NTD 97877.02, whereas younger individuals had costs of NTD 87725.00 (Table 1).

Table 1.

Characteristic of trauma patients

	Young patients (n = 3442)	Elderly patients (n = 1743)	p
Age	39.32 ± 16.71	78.09 ± 8.47
Gender			<0.001
Male	2188 (63.57%)	828 (47.50%)
Female	1254 (36.43%)	915 (53.50%)
Arrival method			0.005
Self-arrival	1131 (32.86%)	622 (35.69%)
Transported by (EMS)	1391 (40.41%)	617 (35.40%)
Transferred	920 (26.73%)	504 (28.91%)
SBP <90 mmHg	57 (1.66%)	17 (0.98%)	0.039
BMI	25.01	23.8	0.451
Mechanism			<0.001
Blunt	2979 (86.55%)	1676 (96.16%)
Traffic accident	1963 (57.03%)	568 (32.59%)
Fall	831 (24.14%)	1086 (62.31%)
Crush injury	185 (5.37%)	22 (1.26%)
Penetrating	190 (5.52%)	21 (1.20%)
Other	273 (7.93%)	46 (2.64%)
pRBC in 24 h	166 (4.82%)	59 (3.38%)	0.016
ISS
Mean	7.72 ± 7.35	8.96 ± 5.73	<0.001
Median	4	9
ISS ≥16	411 (11.91%)	197 (11.54%)	0.500
AIS ≥3
Head and neck	446 (12.96%)	293 (16.81%)	<0.001
Face	24 (0.70%)	2 (0.11%)	0.005
Chest	378 (10.98%)	179 (10.27%)	0.434
Abdomen	145 (4.21%)	33 (1.89%)	<0.001
Extremity	428 (12.43%)	716 (41.08%)	<0.001
External	14 (0.29%)	1 (0.06%)	0.085
LOS in ICU	5.54 ± 9.58	6.61 ± 8.85	0.51
LOS	7.86 ± 10.16	9.36 ± 11.10	<0.001
Total cost	114018.91	122918.01	0.090
NHI cost	87725.00	97877.02	0.044
Self-pay	27620.15	25957.97	0.211
Comorbidity	498 (14.47%)	921 (52.84%)	<0.001
Complication	73 (2.12%)	102 (5.85%)	<0.001
Mortality	48 (1.39%)	80 (4.59%)	<0.001

AIS = Abbreviated Injury Scale; BMI = body mass index; EMS = emergency medical services; ICU = intensive care unit; ISS = Injury Severity Score; LOS = length of stay; NHI = National Health Insurance; pRBC = packed red blood cell; SBP = systolic blood pressure.

Logistic regression was used for the multivariate analysis to investigate the relationship between factors, with statistically significant differences identified in the single-factor analyses. We observed a higher probability of death with increasing age, characterized by an odds ratio (OR) of 1.101 (95% CI, 1.014-1.196, p = 0.022). Furthermore, as the Glasgow Coma Scale (GCS) score of the patients decreased, the probability of death increased, with an OR of 0.806 (CI, 0.725-0.896, p < 0.001). Patients with an ISS ≥16 have a higher likelihood of mortality compared to those with ISS <16, with an OR of 3.594 (CI, 0.564-3.325, p = 0.030). Patients experiencing complications had a higher probability of mortality, with an OR of 5.597 (CI, 2.304-13.597, p < 0.001). Patients who underwent surgery had a lower probability of death, with an OR of 0.328 (CI, 0.134-0.799, p = 0.014). Patients presenting with hypotension in the emergency department had a higher probability of mortality, with an OR of 7.687 (9 CI, 1.661-35.570, p = 0.009) (Table 2).

Table 2.

Multifactorial analysis of factors related to mortality

	OR (95% CI)	p
Age	1.101 (1.014-1.196)	0.022
ISS	1.030 (0.965-1.100)	0.367
GCS	0.806 (0.725-0.896)	<0.001
Total cost	1.000 (1.000a-1.000b)	0.548
NHI insurance cost	1.000 (1.000c-1.000d)	0.383
Gender (male/female)	1.622 (0.733-3.589)	0.233
ISS ≥16	3.594 (1.133-11.397)	0.030
pRBC in 24 h	3.276 (0.863-12.441)	0.081
Age ≥80 y old	0.744 (0.184-3.001)	0.677
AIS of head and neck ≥3	1.056 (0.348-3.200)	0.924
AIS of abdomen ≥3	1.691 (0.369-7.747)	0.499
AIS of extremity ≥3	0.713 (0.232-2.185)	0.553
Complication (yes/no)	5.597 (2.304-13.597)	<0.001
Surgery (yes/no)	0.328 (0.134-0.799)	0.014
SBP <90 mmHg	7.687 (1.661-35.570)	0.009

AIS = Abbreviated Injury Scale; GCS = Glasgow Coma Scale; ISS = Injury Severity Score; NHI = National Health Insurance; OR = odds ratio; pRBC = packed red blood cell; SBP = systolic blood pressure.

^a0.9999975020871407.

^b1.0000047024812806.

^c0.9999938986491536.

^d1.0000023432053777.

When conducting multivariable analysis, we found that only the ISS, total hospital days, ICU days, undergoing surgery, mortality, ISS ≥16, and Abbreviated Injury Scale (AIS) of external injury ≥3 had statistically significant differences. Higher ISSs in patients, longer hospital stays, increased ICU days, undergoing surgery, and patient mortality during hospitalization, receiving a blood transfusion within 24 hours, and having an AIS of external injury ≥3 were all associated with higher total costs (Table 3).

Table 3.

Multiple linear regression analysis of total costs related factors

	Regression coefficient (95% CI)	p
ISS	3316.133 (839.380-5792.886)	0.009
GCS	2354.642 (−1459.162 to 6168.446)	0.226
LOS	8561.961 (7282.226-9841.696)	<0.001
LOS in ICU	8478.743 (6154.083-10803.404)	<0.001
Gender (male/female)	2592.528 (−20140.231 to 25325.286)	0.823
Complication (yes/no)	8252.027 (−23811.661 to 40315.714)	0.613
Surgery (yes/no)	87324.377 (61842.004-5792.886)	<0.001
Mortality (yes/no)	43808.297 (7790.282-79826.311)	0.017
ISS ≥16	−7646.506 (−43187.284 to 27894.271)	0.673
AIS of head and neck ≥3	−23275.851 (−55215.373 to 8663.672)	0.153
AIS of chest ≥3	−9928.120 (−41260.016 to 21403.777)	0.534
AIS of abdomen ≥3	9907.886 (−41456.629 to 61272.401)	0.705
AIS of external ≥3	935143.192 (693010.641-1177275.743)	<0.001
pRBC in 24 h	44099.314 (1855.725-86342.903)	0.041
Mechanism (TA/not TA)	−15938.301 (−39092.575 to 7215.972)	0.177

AIS = Abbreviated Injury Scale; GCS = Glasgow Coma Scale; ICU = intensive care unit; ISS = Injury Severity Score; LOS = length of hospital stay; pRBC = packed red blood cell; TA = traffic accident.

4. DISCUSSION

Our results align with the statistics from Burstow in New Zealand; among elderly patients with trauma, there was a higher proportion of female patients.⁷ In terms of injury mechanisms, older individuals experience relatively higher incidence of falls than younger individuals.^8,9 Our results also indicated a higher incidence of falls among the elderly, likely due to reduced mobility, resulting in fewer instances of driving or riding compared with younger individuals. The number of patients involved in accidents tended to decrease with age. Elderly individuals incur higher healthcare expenses than their younger counterparts. This aspect should be considered when formulating trauma reimbursement. As age increased, reimbursement increased proportionally.

Elderly trauma patients exhibit higher mortality rates than younger individuals. This is attributed to the diminished physiological resilience of older adults, which makes them less capable of withstanding the physiological stress imposed by trauma, resulting in a higher mortality rate. The aforementioned statistics from New Zealand align with our findings, indicating a higher mortality rate among older adults (5.6% vs 2.3%). For trauma severity scores <16, the mortality rate in the elderly group was 2.2%, while that in the younger group it was 0.12% (p < 0.001).⁷ Hashmi et al¹⁰ reported that the overall mortality rate in elderly patients with trauma was 14.8%. As age and trauma severity increase, the mortality rate also increases.¹⁰ In a 2008 study conducted by Christensen et al¹¹ in the UK, the overall mortality rate of elderly trauma patients was 7%. In our study, the mortality rate among elderly individuals was 4.59%, and among younger individuals, it was 1.39% (p < 0.001), both lower than in previous studies.

Sex is also associated with mortality rates in the context of trauma. Most studies have indicated a potential correlation with female hormones. For instance, males under the age of 50 years show a higher mortality rate than females, whereas there is no statistically significant difference in those aged fifty and above.¹² A 2000 study by Jarrar et al¹³ showed that in animal experiments, estradiol improved organ functions after trauma hemorrhage. A 2013 study by Petersen et al showed that adult female trauma patients had a higher survival rate than adult males.^14,15 A 2007 study by Frink et al¹⁶ demonstrated that female trauma patients under 50 years of age with an ISS of 25 or higher have lower rates of multiple organ dysfunction and sepsis. In a study by Sammy et al,¹⁷ elderly males exhibited a higher mortality rate compared to females. In our results, regarding factors affecting mortality in elderly patients, the univariate analysis showed an OR of 2.867 (CI, 1.750-4.697, p < 0.001) for males compared to females, which differs from previous studies. This can be explained by variations in the trauma severity scores. For males above 65 years of age, the average trauma severity score was 9.70 (SD = 6.487), while for females it was 8.29 (SD = 4.845, p < 0.001). Therefore, male patients had a more severe level of injury, potentially leading to higher mortality rates. Our study showed that sex did not exhibit significant differences in the multivariate analysis of the factors affecting mortality. Although female hormones were not directly tested in our study, these findings indirectly suggested a potential protective effect of female hormones in patients with trauma.

According to a study by Kuwabara et al¹⁸ in Japan, among all trauma patients, those aged 55 years and older as well as those with injuries to the abdomen, limbs, or pelvic region had a higher mortality rate. In our study, we found that in elderly trauma patients, AIS of abdomen ≥3 and AIS of extremity ≥3 did not impact mortality.

Hashmi et al¹⁰ reported that as age and trauma severity increase, the mortality rate also increases. In a study by Sammy et al,¹⁷ increased trauma severity and number of injured body regions were also linked to higher mortality rates. Our study shows that increasing age (OR: 1.101, 95% CI, 1.014-1.196, p = 0.022) and ISS ≥16 (OR: 3.594, 95% CI, 1.133-11.397, p = 0.030) both increase mortality rates.

Additionally, there was an association between low systolic blood pressure in the emergency department and mortality, with the occurrence of low systolic blood pressure increasing the OR for mortality.¹⁰ In a study by Sammy et al,¹⁷ lower GCS scores and systolic blood pressure were associated with higher mortality. Injuries from low-energy mechanisms have a higher mortality rate than those from motor vehicle accidents.¹⁷ Similarly, we found that a higher mortality rate was associated with lower GCS scores and hypotension in the emergency department. However, unlike the aforementioned studies, injuries resulting from motor vehicle accidents do not show a significant correlation with mortality rates.

In a study conducted by Christensen et al¹¹ in the UK, the median LOS for elderly trauma patients was 9 days, with 69% undergoing surgical treatment. The average LOS for our elderly trauma patients was 9.36 days, similar to that in the study mentioned above. The overall mortality rate was 7%.¹¹ Our study indicated that surgery is associated with a lower mortality rate. Surgery is also associated with a reduced mortality rate, and this holds true for the elderly population as well as for all other demographics.¹⁸ This may mean that the patient or family refused surgery because of poor prognosis or a higher risk of surgical complications. Because patients undergoing surgery generally have relatively better health, the mortality rate is lower.

According to a U.S. study of elderly trauma patients, the severity score can predict respiratory-related complications, gastrointestinal-related complications, and sepsis. The need for surgery, blood transfusion, and sepsis correlated.¹⁹ The 2012 study by Adams et al²⁰ showed that as age increases, the incidence of complications also rises. These complications include integumentary issues, such as decubitus skin ulcers and renal failure; pulmonary complications, such as acute respiratory distress syndrome, pleural effusion, pulmonary edema, and respiratory failure; and cardiac complications, such as arrhythmia, congestive heart failure, cardiac arrest, tamponade, and myocardial infarction.²⁰ Konda et al²¹ highlighted that the primary complications in elderly patients with trauma include urinary tract infections, acute anemia, and acute respiratory failure. Two studies have shown that cardiac, septic, and respiratory complications in elderly trauma patients are associated with high mortality rates.^22,23 Our study found a statistically significant difference in the total LOS, receipt of red blood cell transfusions within 24 hours, and mortality between those who experienced complications and those who did not. Once complications arise, they not only prolong the hospital stay and increase associated expenses but also increase the mortality rate. Therefore, when elderly individuals are hospitalized for trauma, proactive measures should be taken to prevent the onset of complications, and if they occur, they should be promptly addressed. Our study only included variables indicating the presence or absence of complications without examining which types of complications were associated with higher healthcare costs and mortality rates. However, this requires further investigation.

According to a series of international papers, there is a trend toward higher costs associated with trauma in the elderly. In the UK, Christensen et al¹¹ published a study indicating that the average cost of elderly trauma was €9530. Campbell et al²⁴ conducted a study showing that the average cost for significant trauma patients with major bleeding was £19 770. In the United States, a study conducted in the United States two decades ago showed that, at that time, younger trauma patients incurred higher costs compared to elderly patients ($17 817 vs $15 414).²⁵ Another study indicated that the average costs of mild and severe trauma were $13 465.²⁶ In our study, the average cost for significant trauma in elderly individuals (with a severity score of ≥16) was NTD 285 074. The costs associated with elderly trauma in Taiwan were significantly lower than those in other countries.

Regarding the factors that may influence expenses, trends were observed in subsequent studies. According to Christensen et al,¹¹ the factors influencing the total cost of trauma in the elderly include the GCS score, severity score, age, cause of injury, type of injury, in-hospital mortality rate, physician grade, and specialty. In another study by Bail et al,²⁷ in-hospital severity was found to be a better indicator of expenses. In addition, complications during hospitalization and elderly patients with dementia tend to incur higher costs than other issues.²⁷ Our results showed higher healthcare expenses for elderly trauma patients under health insurance coverage, with no statistical difference in total costs. This differs from the 1998 study by Young et al,²⁵ potentially due to variations in trauma severity or advancements in medical care, suggesting reduced ineffective treatments or decreased expenditures among elderly patients in the United States. In our study, we found that mortality influenced expenses in elderly patients with trauma. Trauma severity, LOS, and ICU stay also impact costs. However, surgical procedures are associated with increased expenses. Interestingly, in the cost analysis of trauma in the elderly, age did not exhibit significant differences, which contrasts with a 2008 study by Christensen et al¹¹ in the UK. However, in our study, health insurance expenses were higher for the elderly than for younger individuals. This can be attributed to the broader coverage and fewer restrictions imposed by the Taiwan National Health Insurance system. The provision of insurance benefits may lead to unnecessary tests and hospitalizations, potentially contributing to ineffective medical care. Additionally, defensive medicine practices could result in excessive testing, causing variations in insurance costs while leaving out-of-pocket expenses unaffected. Elderly people tended to have more comorbidities (52.84% vs 14.47%, p < 0.001) and complications (5.85% vs 2.12%, p < 0.001) than younger individuals. More comorbidities and complications result in higher healthcare costs.

Although our study showed that in elderly trauma patients, increasing age was not correlated with increased costs, and there was a significant difference between elderly and younger patients. In the context of trauma in the elderly, the required medical expenses are relatively higher than those for younger individuals. Relevant authorities should consider age when formulating policies related to trauma compensation. Based on our findings, healthcare resource consumption can be reduced by reducing the LOS and mitigating trauma severity. Various measures can be used to reduce the severity of the injury. Falls and traffic accidents are the primary causes of injuries among elderly people, and preventing falls and accidents is the main method for reducing the severity of injuries in the elderly. For example, laws mandating reduced chances of drinking and driving can help accomplish this goal.²⁸ A 2019 study by Liu-Ambrose et al²⁹ demonstrated that exercise training programs could reduce the risk of falls among elderly individuals. In addition, in Taiwan, through the management system for elderly drivers’ licenses, individuals aged 75 years and above must pass a “cognitive function test” or provide proof of not having moderate or severe dementia, in addition to passing a physical examination to renew their motor vehicle licenses, which are valid for three years. This approach helps to reduce the occurrence of accidents involving elderly drivers.

The limitations of this study were as follows. Limitations of the trauma registry data include the following. The data source for this study is the trauma registry database of a public medical center in southern Taiwan, which has inherent limitations. First, because this is a veterans’ hospital, the proportion of veterans is higher than that in other hospitals, which could lead to differences in patient demographics and potentially introduce bias into the results. Second, because the study focused on patients from a single hospital, the patient population may differ from that of other hospitals and the national average. Third, because the registry data were manually entered retrospectively, inevitable registration omissions may occur, which could impact the completeness of the data and influence statistical outcomes.

This study focused on trauma in the elderly, and for older individuals, comorbidities played a crucial role in influencing outcomes. Owing to registration constraints, only the presence or absence of comorbidities was extracted as a variable. Complications and surgical procedures were categorized similarly. Future registrations should consider separate entries for significant categories to facilitate statistical analysis. Further research should address this issue through individual studies.

The cost of this study was extracted from the registry database, and its data source was directly from the information system. These data may differ from the final health insurance reimbursement amount, which is adjusted based on health insurance declaration rules, considering deductions and additions owing to health insurance clawbacks and the diagnosis-related groups (DRG) payment system. This is a limitation of the study, and it is hoped that future research will provide more accurate statistics based on actual reimbursement amounts.

This study only includes a 3-year timeframe, and owing to the relatively small number of patients, statistical conclusions may have been affected by the limited case count. Future research should extend the duration of data collection to enhance statistical accuracy.

The complication rate in this study was lower than that reported in international studies, a potential reason for which is the reliance on registry data as the source. The data in the registry were derived from medical records; if complications were not documented in the medical records, the registry personnel were unable to record them, which led to an underestimation of complications. Future improvements should focus on enhancing the completeness of medical records or changing the registration process, allowing registry personnel to review medical records and avoid this issue.

In conclusion, our study indicated that older age was associated with a higher mortality rate. Major trauma, lower consciousness scores, presentation with hypotension in the emergency department, and presence of complications were associated with a higher mortality rate. Surprisingly, surgery has been associated with a reduced mortality rate. National Health Insurance expenses are higher for elderly individuals than for younger individuals with trauma. Elderly patients had a longer LOS, higher mortality and complication rates, and higher total medical costs. The required medical expenses for elderly trauma cases were relatively higher than those for younger individuals. Relevant authorities should consider patient age when formulating policies for trauma reimbursement. As age increased, reimbursement increased proportionally. According to our findings, healthcare resource utilization may be reduced by reducing the LOS and mitigating trauma severity. However, further research is required to confirm these findings. We recommend collecting more detailed data, extending the study period, and engaging in multicenter collaborations to validate our findings and provide a roadmap for further research. We suggested that interventional studies are needed to test strategies aimed at reducing resource utilization and improving outcomes in elderly trauma patients, which would be valuable.