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L'Huillier JC, Logghe HJ, Hua S, Myneni AA, Noyes K, Yu J, Guo WA. The Magic Number 63 - Redefining the Geriatric Age for Massive Transfusion in Trauma. J Surg Res 2024; 301:205-214. [PMID: 38954988 DOI: 10.1016/j.jss.2024.04.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/20/2024] [Accepted: 04/29/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION The arbitrary geriatric age cutoff of 65 may not accurately define older adults at higher risk of mortality following massive transfusion (MT). We sought to redefine a new geriatric age threshold for MT and understand its association with outcomes. MATERIAL AND METHODS The 2013-2018 Trauma Quality Improvement Program database was queried for all adults who received ≥10 units of packed red blood cells (pRBCs) within 24 h of admission. A bootstrap analysis using multiple logistic regression established transfusion futility thresholds (TTs), where additional pRBCs no longer improved mortality for various age cutoffs. The age cutoff at which the TT for those relatively older and relatively younger was statistically significant was used to define the new "geriatric" age for MT. Outcomes were then compared between the newly defined geriatric and nongeriatric patients. RESULTS The difference in TT first became significant when the age cutoff was 63 y. The TT for patients aged ≥63 y (new geriatric, n = 2870) versus <63 y (nongeriatric, n = 17,302) was 34 and 40 units of pRBCs, respectively (P = 0.04). Although geriatric patients had a higher Glasgow coma scale score (9 versus 6, P < 0.01) and lower abbreviated injury score-abdomen (3 versus 4, P < 0.01) than the nongeriatric, they suffered higher overall mortality (62% versus 45%, P < 0.01). A lower percentage of geriatric patients were discharged to home (7% versus 35%, P < 0.01). CONCLUSIONS The new geriatric age for MT is 63 y, with a TT of 34 units. Despite suffering less severe injuries, physiologically "geriatric" patients have worse outcomes following MT.
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Affiliation(s)
- Joseph C L'Huillier
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York; Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Erie County Medical Center, Buffalo, New York
| | - Heather J Logghe
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Erie County Medical Center, Buffalo, New York
| | - Shuangcheng Hua
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Ajay A Myneni
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Katia Noyes
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Jihnhee Yu
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Weidun Alan Guo
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Erie County Medical Center, Buffalo, New York.
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Pivetta LGA, Antunes PDESL, Shimoda GM, Parreira JG, Perlingeiro JAG, Assef JC. Trauma Registry: Trauma Quality indicators analysis in hospitalized patients. Rev Col Bras Cir 2024; 51:e20243604. [PMID: 38597571 PMCID: PMC11185059 DOI: 10.1590/0100-6991e-20243604-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/04/2023] [Indexed: 04/11/2024] Open
Abstract
PURPOSE to consolidate a Trauma Register (TR) trough REDCap data acquisition platform and to validate, in this context, local Quality Indicators (QI) as improvement opportunities in trauma management. METHODS continuous data acquisition of all patients admitted in Irmandade da Santa Casa de Misericórdia de São Paulo adult Trauma bay and it's validation in REDCap platform; 6 months retrospective cohort of QI impact in length of hospitalar stay, complications and mortality. Fisher, Chi-squared, Wilcoxon and Kruskal-Wallis tests were used to correlate QIs fails with the endpoints, considering p<0.05 and CI <95% as statically significant. RESULTS 465 were admitted in Trauma bay, with 137 patients hospitalized (29.5%); the number of QIs compromised were related with more complications (p=0.075) and increased length of stay (p=0.028), especially the delay in open fracture's surgical management, which increased the severe complications' incidence (p=0.005). CONCLUSION the REDCap data acquisition platform is useful as a tool for multi center TR implementation, from ethical and logistical point of view; nevertheless, the proposed QIs are validated as attention points in trauma management, allowing improvements in traumatized patients treatment.
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Affiliation(s)
| | | | | | - José Gustavo Parreira
- Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | | | - Jose Cesar Assef
- Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
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Kregel HR, Hatton GE, Harvin JA, Puzio TJ, Wade CE, Kao LS. Identifying Age-Specific Risk Factors for Poor Outcomes After Trauma With Machine Learning. J Surg Res 2024; 296:465-471. [PMID: 38320366 DOI: 10.1016/j.jss.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Risk stratification for poor outcomes is not currently age-specific. Risk stratification of older patients based on observational cohorts primarily composed of young patients may result in suboptimal clinical care and inaccurate quality benchmarking. We assessed two hypotheses. First, we hypothesized that risk factors for poor outcomes after trauma are age-dependent and, second, that the relative importance of various risk factors are also age-dependent. METHODS A cohort study of severely injured adult trauma patients admitted to the intensive care unit 2014-2018 was performed using trauma registry data. Random forest algorithms predicting poor outcomes (death or complication) were built and validated using three cohorts: (1) patients of all ages, (2) younger patients, and (3) older patients. Older patients were defined as aged 55 y or more to maintain consistency with prior trauma literature. Complications assessed included acute renal failure, acute respiratory distress syndrome, cardiac arrest, unplanned intubation, unplanned intensive care unit admission, and unplanned return to the operating room, as defined by the trauma quality improvement program. Mean decrease in model accuracy (MDA), if each variable was removed and scaled to a Z-score, was calculated. MDA change ≥4 standard deviations between age cohorts was considered significant. RESULTS Of 5489 patients, 25% were older. Poor outcomes occurred in 12% of younger and 33% of older patients. Head injury was the most important predictor of poor outcome in all cohorts. In the full cohort, age was the most important predictor of poor outcomes after head injury. Within age cohorts, the most important predictors of poor outcomes, after head injury, were surgery requirement in younger patients and arrival Glasgow Coma Scale in older patients. Compared to younger patients, head injury and arrival Glasgow Coma Scale had the greatest increase in importance for older patients, while systolic blood pressure had the greatest decrease in importance. CONCLUSIONS Supervised machine learning identified differences in risk factors and their relative associations with poor outcomes based on age. Age-specific models may improve hospital benchmarking and identify quality improvement targets for older trauma patients.
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Affiliation(s)
- Heather R Kregel
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas.
| | - Gabrielle E Hatton
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
| | - John A Harvin
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
| | - Thaddeus J Puzio
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas
| | - Charles E Wade
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
| | - Lillian S Kao
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
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Ferrah N, Kennedy B, Beck B, Ibrahim J, Gabbe B, Cameron P. A scoping review of models of care for the management of older trauma patients. Injury 2024; 55:111200. [PMID: 38035863 DOI: 10.1016/j.injury.2023.111200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The number of older people hospitalised with major trauma is rapidly increasing. New models of care have emerged, such as co-management, and trauma centres dedicated to delivering geriatric trauma care. The aim of this scoping review was to explore in-hospital models of care for older adults who experience physical trauma. PATIENTS AND METHODS The search was conducted in accordance with the PRISMA- SC (preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews) reporting guidelines. The National Heart Lung, and Blood Institute (NIH) study quality assessment tool was used to evaluate risk of bias in before and after non-randomised experimental studies. RESULTS Of 2127 records returned from the database search, 43 papers were included. We identified five types of care models investigated in the reviewed studies: centralised trauma management, consultation services, co-management, patient care protocols, and alert and triage systems. The majority of patients were admitted under a specialised trauma service, intervention teams were for the most part multidisciplinary, and follow-up of patients post-discharge was seldom reported. Consultation services more often had advanced care and discharge planning as treatment objectives. In contrast, patient care protocol and alert systems commonly had management of anticoagulation as a treatment objective. Overall, the impact of the five models of care on patient outcomes was mixed. DISCUSSION Given the variability in patient characteristics and capabilities of health services, models of care need to be matched to the local profile of older trauma patients. However, some standards should be incorporated into a care model, including identifying goals of care, medication review and follow up post-discharge.
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Affiliation(s)
- Noha Ferrah
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia.
| | - Briohny Kennedy
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Department of Forensic Medicine, Monash University, The Victorian Institute of Forensic Medicine, Victoria Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Faculty of Medicine, Laval University, Quebec City, Canada
| | - Joseph Ibrahim
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Department of Forensic Medicine, Monash University, The Victorian Institute of Forensic Medicine, Victoria Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Health Data Research UK, Swansea University Medical School, UK
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Emergency and Trauma Centre, The Alfred Hospital, Victoria, Australia
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Long TK, Booza SD, Turner LN. Identification of Seniors at Risk Score to Determine Geriatric Evaluations on Trauma Patients With Hip Fractures. J Trauma Nurs 2023; 30:142-149. [PMID: 37144802 DOI: 10.1097/jtn.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Trauma centers are confronted with rising numbers of geriatric trauma patients at high risk for adverse outcomes. Geriatric screening is advocated but not standardized within trauma centers. OBJECTIVE This study aims to describe the impact of Identification of Seniors at Risk (ISAR) screening on patient outcomes and geriatric evaluations. METHODS This study used a pre-/postdesign to assess the impact of ISAR screening on patient outcomes and geriatric evaluations in trauma patients 60 years and older, comparing the periods before (2014-2016) and after (2017-2019) screening implementation. RESULTS Charts for 1,142 patients were reviewed. Comparing pre- to post-ISAR groups, the post-ISAR group with geriatric evaluations were older (M = 82.06, SD = 9.51 vs. M = 83.64, SD = 8.69; p = .026) with higher Injury Severity Scores (M = 9.22, SD = 0.69 vs. M = 9.38, SD = 0.92; p = .001). There was no significant difference in length of stay, intensive care unit length of stay, readmission rate, hospice consults, or inhospital mortality. Inhospital mortality (n = 8/380, 2.11% vs. n = 4/434, 0.92%) and length of stay in hours (M = 136.49, SD = 67.09 vs. M = 132.53, SD = 69.06) down-trended in the postgroup with geriatric evaluation. CONCLUSION Resources and care coordination efforts can be directed toward specific geriatric screening scores to achieve optimal outcomes. Varying results were found related to outcomes of geriatric evaluations prompting future research.
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Affiliation(s)
- Taylor K Long
- Senior Health Services (Dr Long) and Trauma Services (Ms Booza), Henry Ford Macomb Hospital, Clinton Township, Michigan; and College of Osteopathic Medicine, Michigan State University, Clinton Township (Dr Turner)
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Halter M, Jarman H, Moss P, Kulnik ST, Baramova D, Gavalova L, Cole E, Crouch R, Baxter M. Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review. BMJ Open 2023; 13:e066329. [PMID: 36810176 PMCID: PMC9944672 DOI: 10.1136/bmjopen-2022-066329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/15/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To systematically review research on acute hospital care for frail or older adults experiencing moderate to major trauma. SETTING Electronic databases (Medline, Embase, ASSIA, CINAHL Plus, SCOPUS, PsycINFO, EconLit, The Cochrane Library) were searched using index and key words, and reference lists and related articles hand-searched. INCLUDED ARTICLES Peer-reviewed articles of any study design, published in English, 1999-2020 inclusive, referring to models of care for frail and/or older people in the acute hospital phase of care following traumatic injury defined as either moderate or major (mean or median Injury Severity Score ≥9). Excluded articles reported no empirical findings, were abstracts or literature reviews, or referred to frailty screening alone. METHODS Screening abstracts and full text, and completing data extractions and quality assessments using QualSyst was a blinded parallel process. A narrative synthesis, grouped by intervention type, was undertaken. OUTCOME MEASURES Any outcomes reported for patients, staff or care system. RESULTS 17 603 references were identified and 518 read in full; 22 were included-frailty and major trauma (n=0), frailty and moderate trauma (n=1), older people and major trauma (n=8), moderate or major trauma (n=7) 0r moderate trauma (n=6) . Studies were observational, heterogeneous in intervention and with variable methodological quality.Specific attention given to the care of older and/or frail people with moderate to major trauma in the North American context resulted in improvements to in-hospital processes and clinical outcomes, but highlights a relative paucity of evidence, particularly in relation to the first 48 hours post-injury. CONCLUSIONS This systematic review supports the need for, and further research into an intervention to address the care of frail and/or older patients with major trauma, and for the careful definition of age and frailty in relation to moderate or major trauma. INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS PROSPERO: CRD42016032895.
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Affiliation(s)
- Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Heather Jarman
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Phil Moss
- Emergency department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Desislava Baramova
- Emergency Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Lucia Gavalova
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Elaine Cole
- Trauma Sciences, Queen Mary University of London, London, UK
| | - Robert Crouch
- Health Sciences, University of Southampton, Southampton, UK
| | - Mark Baxter
- Geriatric Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Kregel HR, Puzio TJ, Adams SD. Frailty in the Geriatric Trauma Patient: a Review on Assessments, Interventions, and Lessons from Other Surgical Subspecialties. CURRENT TRAUMA REPORTS 2022. [DOI: 10.1007/s40719-022-00241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karam BS, Patnaik R, Murphy P, deRoon-Cassini TA, Trevino C, Hemmila MR, Haines K, Puzio TJ, Charles A, Tignanelli C, Morris R. Improving mortality in older adult trauma patients: Are we doing better? J Trauma Acute Care Surg 2022; 92:413-421. [PMID: 34554138 DOI: 10.1097/ta.0000000000003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Older adult trauma is associated with high morbidity and mortality. Individuals older than 65 years are expected to make up more than 21% of the total population and almost 39% of trauma admissions by 2050. Our objective was to perform a national review of older adult trauma mortality and identify associated risk factors to highlight potential areas for improvement in quality of care. MATERIALS AND METHODS This is a retrospective cohort study of the National Trauma Data Bank including all patients age ≥65 years with at least one International Classification of Diseases, Ninth Revision, Clinical Modification trauma code admitted to a Level I or II US trauma center between 2007 and 2015. Variables examined included demographics, comorbidities, emergency department vitals, injury characteristics, and trauma center characteristics. Multilevel mixed-effect logistic regression was performed to identify independent risk factors of in-hospital mortality. RESULTS There were 1,492,759 patients included in this study. The number of older adult trauma patients increased from 88,056 in 2007 to 158,929 in 2015 (p > 0.001). Adjusted in-hospital mortality decreased in 2014 to 2015 (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.86-0.91) when compared with 2007 to 2009. Admission to a university hospital was protective (OR, 0.83; 95% CI, 0.74-0.93) as compared with a community hospital admission. There was no difference in mortality risk between Level II and Level I admission (OR, 1.00; 95% CI, 0.92-1.08). The strongest trauma-related risk factor for in-patient mortality was pancreas/bowel injury (OR, 2.25; 95% CI, 2.04-2.49). CONCLUSION Mortality in older trauma patients is decreasing over time, indicating an improvement in the quality of trauma care. The outcomes of university based hospitals can be used as national benchmarks to guide quality metrics. LEVEL OF EVIDENCE Therapeutic/Care Management, Level IV.
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Affiliation(s)
- Basil S Karam
- From the Department of Surgery (B.S.K., R.P., P.M., T.A.d.-C., Co.T., R.M.), Comprehensive Injury Center (T.A.d.-C.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (M.R.H.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (K.H.), Duke University, Durham, North Carolina; Department of Surgery (T.J.P.), University of Texas Health Science Center, Houston, Texas; Department of Surgery (A.C.), School of Public Health (A.C.), University of North Carolina, Chapel Hill, North Carolina; Department of Surgery (Ch.T.), Institute for Health Informatics (Ch.T.), University of Minnesota, Minneapolis; and Department of Surgery (Ch.T.), North Memorial Health Hospital, Robbinsdale, Minnesota
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Thillainadesan J, Hilmer SN, Mudge AM, Aitken SJ, Kearney L, Monaro SR, Li SJ, Schasser S, Kerdic R, Tang R, Naganathan V. Understanding the Role and Value of Process Quality Indicators in Older Vascular Surgery Inpatients. J Surg Res 2021; 267:91-101. [PMID: 34174695 DOI: 10.1016/j.jss.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the development of geriatrics surgery process quality indicators (QIs), few studies have reported on these QIs in routine surgical practice. Even less is known about the links between these QIs and clinical outcomes, and patient characteristics. We aimed to measure geriatrics surgery process QIs, and investigate the association between process QIs and outcomes, and QIs and patient characteristics, in hospitalized older vascular surgery patients. METHODS This was a prospective cohort study of 150 consecutive patients aged ≥ 65 years admitted to a tertiary vascular surgery unit. Occurrence of geriatrics surgery process QIs as part of routine vascular surgery care was measured. Associations between QIs and high-risk patient characteristics, and QIs and clinical outcomes were assessed using clustered heatmaps. RESULTS QI occurrence rate varied substantially from 2% to 93%. Some QIs, such as cognition and delirium screening, documented treatment preferences, and geriatrician consultation were infrequent and clustered with high-risk patient characteristcs. There were two major process-outcome clusters: (a) multidisciplinary consultations, communication and screening-based process QIs with multiple adverse outcomes, and (b) documentation and prescribing-related QIs with fewer adverse outcomes. CONCLUSIONS Clustering patterns of process QIs with clinical outcomes are complex, and there is a differential occurrence of QIs by patient characteristics. Prospective intervention studies that report on implemented QIs, outcomes and patient characteristics are needed to better understand the causal pathways between process QIs and outcomes, and to help prioritize targets for quality improvement in the care of older surgical patients.
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Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Sydney, Australia; Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord, Sydney, Australia.
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Alison M Mudge
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia and University of Queensland School of Clinical Medicine, Brisbane, Queensland, Australia
| | - Sarah J Aitken
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Sydney, Australia; Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord, Sydney, Australia; Concord Institute of Academic Surgery, Vascular Surgery Department, Concord Hospital, Concord, Sydney, Australia; Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia
| | - Leanne Kearney
- Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord, Sydney, Australia
| | - Sue R Monaro
- Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia; Susan Wakil School of Nursing, The University of Sydney, Sydney, New South Wales, Australia
| | - Susan J Li
- Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia
| | - Sue Schasser
- Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia
| | - Richard Kerdic
- Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia
| | - Robert Tang
- Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia
| | - Vasi Naganathan
- Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Sydney, Australia; Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord, Sydney, Australia
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Complications in low-risk older adult trauma patients: A case-control study. J Trauma Acute Care Surg 2020; 86:858-863. [PMID: 30633098 DOI: 10.1097/ta.0000000000002204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although some geriatric trauma patients may be at low risk of complications, poor outcomes are pronounced if complications do occur. Prevention in this group decreases the risk of excess morbidity and mortality. METHODS We performed a case-control study of trauma patients 65 years or older treated from January 2015 to August 2016 at a Level I trauma center with a Trauma Quality Improvement Program-predicted probability of complication of less than 20%. Cases had one of the following complications: unplanned admission to the intensive care unit (ICU), unplanned intubation, pneumonia, or unplanned return to the operating room. Two age-matched controls were randomly selected for each case. We collected information on comorbidities, home medications, and early medical care and calculated odds ratios using multivariable conditional logistic regression. RESULTS Ninety-four patients experienced unplanned admission to ICU (n = 51), unplanned intubation (n = 14), pneumonia (n = 21), and unplanned return to the operating room (n = 8). The 188 controls were more frequently intubated and had higher median ISS but were otherwise similar to cases. The adjusted odds of complication were higher for patients on a home β-blocker (adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.2-4.0) and home anticoagulation (aOR, 2.2; 95% CI, 1.2-4.1). Patients with diabetes (aOR 2.0; 95% CI, 1.1-3.7) and dementia (aOR, 2.0; 95% CI, 1.0-4.3) also had higher odds of complication. The adjusted odds of complication for patients receiving geriatrics consultation was 0.4 (95% CI, 0.2-1.0; p = 0.05). Pain service consultation and indwelling pain catheter placement may be protective, but CIs included 1. There was no association between opiates, benzodiazepines, fluid administration, or blood products in the first 24 hours and odds of complication. CONCLUSIONS Geriatrics consultation was associated with lower odds of unplanned admission to the ICU, unplanned intubation, pneumonia, and unplanned return to the operating room in low-risk older adult trauma patients. Pathways that support expanding comanagement strategies with geriatricians are needed. LEVEL OF EVIDENCE Therapeutic/Care management, Level IV.
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Tillou A, Hiatt JR. When I'm 64 (Slices)-Prognostication in Geriatric Trauma. JAMA Surg 2019; 154:723-724. [PMID: 31066891 DOI: 10.1001/jamasurg.2019.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Areti Tillou
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Jonathan R Hiatt
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles
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Bryant EA, Tulebaev S, Castillo-Angeles M, Moberg E, Senglaub SS, O'Mara L, McDonald M, Salim A, Cooper Z. Frailty Identification and Care Pathway: An Interdisciplinary Approach to Care for Older Trauma Patients. J Am Coll Surg 2019; 228:852-859.e1. [PMID: 30959106 DOI: 10.1016/j.jamcollsurg.2019.02.052] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/08/2019] [Accepted: 02/15/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Frailty is a well-established marker of poor outcomes in geriatric trauma patients. There are few interventions to improve outcomes in this growing population. Our goal was to determine if an interdisciplinary care pathway for frail trauma patients improved in-hospital mortality, complications, and 30-day readmissions. STUDY DESIGN This was a retrospective cohort study of frail patients ≥65 years old, admitted to the trauma service at an academic, urban level I trauma center between 2015 and 2017. Patients transferred to other services and those who died within the first 24 hours were excluded. An interdisciplinary protocol for frail trauma patients, including early ambulation, bowel/pain regimens, nonpharmacologic delirium prevention, nutrition/physical therapy consults, and geriatrics assessments, was implemented in 2016. Our main outcomes were delirium, complications, in-hospital mortality, and 30-day readmission, which were compared with these outcomes in patients treated the year before the pathway was implemented. Multivariate logistic regression was used to determine the association of being on the pathway with outcomes. RESULTS There were 125 and 144 frail patients in the pre- and post-intervention cohorts, respectively. There were no significant demographic differences between the 2 groups. Among both groups, the mean age was 83.51 years (SD 7.11 years), 60.59% were female, and median Injury Severity Score was 10 (interquartile range 9 to 14). In univariate analysis, there were no significant differences in complications (28.0% vs 28.5%, respectively, p = 0.93); however, there was a significant decrease in delirium (21.6% to 12.5%, respectively, p = 0.04) and 30-day readmission (9.6% to 2.7%, respectively, p = 0.01). After adjusting for patient characteristics, patients on the pathway had lower delirium (odds ratio [OR] 0.44, 95% CI 0.22 to 0.88, p = 0.02) and 30-day readmission rates (OR 0.25, 95% CI 0.07 to 0.84, p = 0.02), than pre-pathway patients. CONCLUSIONS An interdisciplinary care protocol for frail geriatric trauma patients significantly decreases their delirium and 30-day readmission risk. Implementing pathways standardizing care for these vulnerable patients could improve their outcomes after trauma.
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Affiliation(s)
- Elizabeth A Bryant
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Samir Tulebaev
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Manuel Castillo-Angeles
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Esther Moberg
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Steven S Senglaub
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Lynne O'Mara
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Meghan McDonald
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Ali Salim
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Zara Cooper
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
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Dhillon NK, Linaval NT, Patel KA, Colovos C, Ko A, Margulies DR, Ley EJ, Barmparas G. Helicopter Transport Use for Trauma Patients Is Decreasing Significantly Nationwide but Remains Overutilized. Am Surg 2018. [DOI: 10.1177/000313481808401019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rapid transfer of trauma patients to a trauma center for definitive management is essential to increase survival. The utilization of helicopter transportation for this purpose remains heavily debated. The purpose of this study was to characterize the trends in helicopter transportations of trauma patients in the United States over the last decade. Subjects with a primary mode of either ground or helicopter transportation were selected from the National Trauma Data Bank datasets 2007 to 2015. Over this period, the proportion of patients transported by a helicopter decreased significantly in a linear fashion from 17 per cent in 2007 to 10.2 per cent in 2015 ( P < 0.001). The overall mortality of this population was 7.6 per cent and remained unchanged over the study period ( P = 0.545). Almost 3 of 10 subjects (29.4%) transported by a helicopter had an Injury Severity Score <9. The proportion of elderly (>65 years) patients requiring helicopter transportation increased by 69.1 per cent, whereas their associated mortality decreased by 21.5 per cent. The use of a helicopter for the transportation of trauma patients has significantly decreased over the last decade without any significant change in mortality, possibly indicating more effective utilization of available resources. Overtriage of patients with minor injuries remained relatively unchanged.
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Affiliation(s)
- Navpreet K. Dhillon
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nikhil T. Linaval
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kavita A. Patel
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Christos Colovos
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ara Ko
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel R. Margulies
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J. Ley
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Galinos Barmparas
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
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Burstow M, Civil I, Hsee L. Trauma in the Elderly: Demographic Trends (1995–2014) in a Major New Zealand Trauma Centre. World J Surg 2018; 43:466-475. [DOI: 10.1007/s00268-018-4794-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Grigorian A, Nahmias J, Schubl S, Gabriel V, Bernal N, Joe V. Rising mortality in patients with combined burn and trauma. Burns 2018; 44:1989-1996. [PMID: 30075972 DOI: 10.1016/j.burns.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/07/2018] [Accepted: 07/13/2018] [Indexed: 01/29/2023]
Abstract
Combined trauma in the burn patient has been previously shown to have higher mortality. With improved critical care and multidisciplinary approach, we hypothesized the risk of mortality in combined burn and trauma has decreased. A retrospective analysis of trauma, burn and combined burn-trauma patients in the National Trauma Data Bank was performed comparing years 2007-2015 to years 1994-2002. The impact of burn injuries on mortality in patients with minor trauma has decreased (OR 2.45, CI 2.26-2.66, p<0.001 compared to OR 4.04, CI 4.51-4.66, p<0.001) in years 2007-2015 while the impact of burn injuries on mortality in patients with severe trauma has increased (OR 1.37, CI 1.29-1.47, p<0.001 compared to OR 1.26, CI 1.05-1.51, p<0.001). When controlling for known risk factors of mortality in burn and trauma, the contribution of the severity of trauma on mortality in combined burn-trauma patients with total body surface area ≥20% is negligible. In contrast, an increase in percentage of total body surface area burned is associated with a step-wise increase in mortality for all combined burn-trauma patients. However, the largest impact is seen in patients with minor trauma. This population represents a unique overlap of patients where future collaborative research can help identify best practices and improve outcomes.
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Affiliation(s)
- Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Sebastian Schubl
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Viktor Gabriel
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Nicole Bernal
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Victor Joe
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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Equal Access Is Quality: an Update on the State of Disparities Research in Trauma. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0114-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Byerly S, Benjamin E, Biswas S, Cho J, Wang E, Wong MD, Inaba K, Demetriades D. Peak creatinine kinase level is a key adjunct in the evaluation of critically ill trauma patients. Am J Surg 2017; 214:201-206. [DOI: 10.1016/j.amjsurg.2016.11.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 02/06/2023]
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Abstract
This article describes geriatric trauma and commonly associated difficulties emphasizing both the epidemiology and assessment of geriatric trauma. There is little data guiding decisions for trauma patients 65 years or older, as there are many unique characteristics to the geriatric population, including comorbidities, medications, and the aging physiology. The geriatric population in the United States has been steadily climbing for the last 20 years and is projected to continue on this trend. Although each patient presents differently, there remains a need for the consistent utilization of standard guidelines to help dictate care for geriatric patients, particularly for patients not receiving care at a trauma center. This review uses a case study about an elderly woman with many comorbidities, followed by a comprehensive discussion of geriatric trauma and the challenges that result from a lack of guideline utilization to direct management.
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Abstract
BACKGROUND Because of the unique physiology and comorbidities of injured geriatric patients, specific interventions are needed to improve outcomes. The purpose of this study was to assess the effect of a change in triage criteria for injured geriatric patients evaluated at an American College of Surgeons Level I trauma center. METHODS As of October 1, 2013, all injured patients 70 years or older were mandated to have the highest-level trauma activation upon emergency department (ED) arrival regardless of physiology or mechanism of injury. Patients admitted before that date were designated as PRE; those admitted after were designated as POST. The study period was from October 1, 2011, through April 30, 2015. Data collected included demographics, mechanism of injury, hypotension on admission, comorbidities, Injury Severity Score (ISS), ED length of stay (LOS), complications, and mortality. Bivariate and multivariable analyses were used to compare outcomes between the study groups (p < 0.05 was considered significant). χ or Fisher's exact test was used as appropriate for bivariate analyses of categorical variables; patients' ages were compared using the Wilcoxon rank-sum test. RESULTS A total of 2,269 patients (mean, 80.63 years; mean ISS, 12.2; PRE, 1,271; POST, 933) were included in the study. On multivariable analysis, increasing age, higher ISS, and hypotension were associated with higher mortality. POST patients were more likely to have an ED LOS of 2 hours or shorter (odds ratio, 1.614; 95% confidence interval, 1.088-2.394) after controlling for hypotension, ISS, and comorbidities. POST mortality significantly decreased (odds ratio, 0.689; 95% confidence interval, 0.484-0.979). CONCLUSION Based on age alone, the focused intervention of a higher level of trauma activation decreased ED LOS and mortality in injured geriatric patients. LEVEL OF EVIDENCE Therapeutic/care management study, level IV.
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Peñasco Y, González-Castro A, Rodríguez-Borregán JC, Llorca J. Base excess, a useful marker in the prognosis of chest trauma in the geriatric population. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:250-256. [PMID: 28162786 DOI: 10.1016/j.redar.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the usefulness of the determination of base excess in a cohort of elderly patients admitted to an intensive care unit (ICU) with a diagnosis of chest trauma. MATERIAL AND METHOD Two hundred and forty-nine patients were included aged 65 years and over with a diagnosis of thoracic trauma who required admission to the ICU. We made a statistical analysis in order to determine the association of the first base excess levels with mortality during the unit stay. RESULTS Two hundred and forty-nine patients, with a mean APACHE II score of 16.21±7.87 and 24.45±14.16 ISS. Mean ICU stay was 12.74±16.85 days and the mean hospital stay was 26.55±30.1 days. Statistical analysis showed an association with mortality in patients whose blood pressure was lower than 110mmHg on admission, with an OR=4.11 (95% CI 1.91 to 8.85) compared to patients with blood pressure between 110 and 140mmHg. Those patients who had base excess levels on admission of less than -6mmol/L also showed increased mortality compared to patients with higher levels, with an OR=3.12 (95% CI 1.51 to 6.42). CONCLUSIONS The presence of a base excess level of less than -6 is associated with increased mortality in elderly patients with initial blood pressure between 110 and 140mmHg, diagnosed with thoracic trauma and who require admission to ICU. Routine measurement of this parameter in this population may show the clinical usefulness of assessing possible hidden hypoperfusion.
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Affiliation(s)
- Y Peñasco
- Departamento de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - A González-Castro
- Departamento de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J C Rodríguez-Borregán
- Departamento de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Llorca
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Cantabria, Santander, España
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Southerland LT, Gure TR, Ruter DI, Li MM, Evans DC. Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines. J Surg Res 2017; 216:56-64. [PMID: 28807214 DOI: 10.1016/j.jss.2017.03.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/31/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The American College of Surgeons' Trauma Quality Improvement Program (TQIP) Geriatric Trauma Management Guidelines recommend geriatric consultation for injured older adults. However it is not known how or whether geriatric consultation improves compliance to these quality measures. METHODS This study is a retrospective chart review of our institutional trauma databank. Adherence to quality measures was compared before and after implementation of specific triggers for geriatric consultation. Secondary analyses evaluated adherence by service: trauma service (Trauma) or a trauma service with early geriatric consultation (GeriTrauma). RESULTS The average age of the 245 patients was 76.7 years, 47% were women, and mean Injury Severity Score was 9.5 (SD ±8.1). Implementation of the GeriTrauma collaborative increased geriatric consultation rates from 2% to 48% but had minimal effect on overall adherence to TQIP quality measures. A secondary analysis comparing those in the post implementation group who received geriatric consultation (n = 94) to those who did not (n = 103) demonstrated higher rates of delirium diagnosis (36.2% vs 14.6%, P < 0.01) and better documentation of initial living situation, code status, and medication list in the GeriTrauma group. Physical therapy was consulted more frequently for GeriTrauma patients (95.7% vs 68.0%, P < 0.01) Documented goals of care discussions were rare and difficult to abstract. A subgroup analysis of only patients with fall-related injuries demonstrated similar outcomes. CONCLUSIONS Early geriatric consultation increases adherence to TQIP guidelines. Further research into the long term significance and validity of these geriatric trauma quality indicators is needed.
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Affiliation(s)
| | - Tanya R Gure
- Department of Internal Medicine, Division of General Internal Medicine and Geriatrics, The Ohio State University, Columbus, OH
| | - Daniel I Ruter
- The Ohio State University College of Medicine, Columbus, OH
| | - Michael M Li
- The Ohio State University College of Medicine, Columbus, OH
| | - David C Evans
- Department of Surgery, The Ohio State University, Columbus, OH
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Abstract
PURPOSE OF REVIEW The geriatric population is the fastest growing segment of the population, and geriatric trauma patients are increasingly common. Caring for this population has unique challenges. The goal of the review is to identify factors that may help in the care of geriatric patients suffering from genitourinary trauma. RECENT FINDINGS Multiple factors lead to inferior outcomes in patients with geriatric trauma including failure to rescue, treatment in lower volume trauma centers, and undertriage of geriatric patients. Improvement in geriatric trauma outcomes occurs with the use of dedicated geriatric consult teams. The surgical management of genitourinary injuries in the geriatric population remains unchanged. SUMMARY Interventions for geriatric patients differ from younger populations. Direct changes in overall management of the geriatric population lead to improved outcomes. The treatment of geriatric trauma patients with genitourinary injuries is similar to a younger cohort. The lack of recent studies in clinical outcomes in this population has been identified as a gap in knowledge that will require future research to answer.
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Abstract
PURPOSE OF REVIEW The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. RECENT FINDINGS Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. SUMMARY Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.
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Peñasco Y, Gonzalez-Castro A, Rodriguez-Borregan JC, Muñoz C, Llorca J. [Evolution of mortality in severe chest trauma in the elderly patient]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2016; 31:204-11. [PMID: 26774695 DOI: 10.1016/j.cali.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/03/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Persons older than 65 years represent about 30% of all cases requiring care for traumatic injury, and is the fifth leading cause of death. Thus, it is considered important to search for epidemiological parameters that can identify this population group. PATIENTS AND METHOD A retrospective, observational, and comparative study was conducted on patients aged 65 years and over admitted to the Intensive Care Unit of tertiary hospital with a primary diagnosis of severe chest trauma between January 1992 and January 2012. A logistic regression was performed to determine the probability of hospital death in relation to the year of hospitalisation. RESULTS The cohort included 235 patients. Univariate logistic regression analysis showed a gradual decrease in the probability of death over the years, with an OR of 0.95 [95% CI; 0.90 to 0.99] for each year of admission after 1992 (P=.029). The multivariate model showed an association of mortality with patient age (OR: 1.08 for year over 65), the score on the scale APACHE II (OR: 1.1 for each point obtained), and need for mechanical ventilation (OR: 5.36). CONCLUSIONS This study shows a decrease in mortality over the years, with an association that remained after adjustment for different confounding parameters.
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Affiliation(s)
- Y Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A Gonzalez-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - J C Rodriguez-Borregan
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - C Muñoz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Llorca
- Facultad de Medicina, Universidad de Cantabria, Santander, España
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Among Patients With Facial Fractures, Geriatric Patients Have an Increased Risk for Associated Injuries. J Oral Maxillofac Surg 2016; 74:1403-9. [DOI: 10.1016/j.joms.2016.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 11/19/2022]
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