Mortality Risk From Prolonged ED Dwell Time in Older Adult Trauma: A National Trauma Data Bank Study.

INTRODUCTION: Emergency department (ED) overcrowding prolongs dwell time; age-related mortality effects remain uncertain. This study evaluated ED dwell time and mortality across pediatric, adult, and older adult trauma populations. METHODS: This retrospective cohort study used the National Trauma Data Bank (2018-2022). Dwell time from ED arrival to ED discharge was described continuously and categorically (0 to 1, 1 to 3, 3 to 8, 8 to 24, >24 h). The exposures of interest were ED dwell time and age. The primary outcome was ED or hospital mortality. Associations between ED dwell time, age, and mortality were evaluated using mixed-effects logistic regression and Cox proportional hazards models. RESULTS: Among 3,701,017 trauma encounters, median ED dwell time was longest among older adults (3.1 h) followed by adults (2.6 h) and pediatric patients (2.4 h). Among patients who died after hospital admission, ED dwell time in older adults (2.1 h) was approximately twice that of adults (1.0 h) and pediatrics (0.8 h). In the mixed-effects model, each additional year of age was associated with a 3.6% increase in mortality odds (adjusted odds ratio [aOR]: 1.036, 95% confidence interval [CI]: 1.03-1.04). In the Cox model, each additional year of age was associated with a 1.3% increase in mortality hazard (hazard ratio [HR]: 1.013, 95% CI: 1.012-1.014). CONCLUSION: Older adults experienced longer ED dwell times and higher adjusted mortality risk. ED dwell time likely reflects both system-level factors, such as operational throughput and patient-level factors, including injury presentation and physiologic vulnerability. These findings support age-informed triage and early risk stratification.