Hypoalbuminemia at admission is associated with increased incidence of in-hospital complications in geriatric trauma patients

BackgroundOlder patients compose approximately 30% of trauma patients treated in the USA but make up nearly 50% of deaths from trauma. To help standardize and elevate care of these patients, the American College of Surgeons (ACS) Trauma Quality Improvement Program’s best practice guidelines for geriatric trauma management was published in 2013 and that for palliative care was published in 2017. Here, we discuss how palliative care and geriatrics quality metrics can be tracked and used for performance improvement and leveraged as a strength for trauma verification.MethodsWe discuss the viewpoint of the ACS Verification, Review, and Consultation and three case studies, with practical tips and takeaways, of how these measures have been implemented at different institutions.ResultsWe describe the use of (1) targeted educational initiatives, (2) development of a consultation tool based on institutional resources, and (3) application of a nurse-led frailty screen.DiscussionSpecialized care and attention to these vulnerable populations is recommended, but the implementation of these programs can take many shapes.Level of evidence V

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The impact of frailty on failure-to-rescue in geriatric trauma patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000001250 ◽

2016 ◽

Vol 81 (6) ◽

pp. 1150-1155 ◽

Cited By ~ 38

Author(s):

Bellal Joseph ◽

Herb Phelan ◽

Ahmed Hassan ◽

Tahereh Orouji Jokar ◽

Terence O’Keeffe ◽

...

Keyword(s):

Geriatric Trauma ◽

Trauma Patients ◽

Failure To Rescue ◽

The Impact

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Direct transport of geriatric trauma patients with pelvic fractures to a Level I trauma center within an organized trauma system: impact on two-week incidence of in-hospital complications

The American Journal of Surgery ◽

10.1016/j.amjsurg.2012.05.020 ◽

2012 ◽

Vol 204 (6) ◽

pp. 921-926 ◽

Cited By ~ 7

Author(s):

Tabitha Garwe ◽

Zachary V. Roberts ◽

Roxie M. Albrecht ◽

Ashley E. Morgan ◽

Jeremy J. Johnson ◽

...

Keyword(s):

Trauma Center ◽

Trauma System ◽

Pelvic Fractures ◽

Geriatric Trauma ◽

Trauma Patients ◽

Level I ◽

System Impact

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Decreased Risk of Delirium With Use of Regional Analgesia in Geriatric Trauma Patients With Multiple Rib Fractures

Annals of Surgery ◽

10.1097/sla.0000000000002929 ◽

2018 ◽

Vol 268 (3) ◽

pp. 534-540 ◽

Cited By ~ 11

Author(s):

Kathleen M. O’Connell ◽

D. Alex Quistberg ◽

Robert Tessler ◽

Bryce R. H. Robinson ◽

Joseph Cuschieri ◽

...

Keyword(s):

Rib Fractures ◽

Geriatric Trauma ◽

Trauma Patients ◽

Regional Analgesia ◽

Multiple Rib Fractures

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Canadian Study of Health and Aging Clinical Frailty Scale: Does It Predict Adverse Outcomes among Geriatric Trauma Patients?

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.08.008 ◽

2017 ◽

Vol 225 (5) ◽

pp. 658-665.e3 ◽

Cited By ~ 24

Author(s):

Annie Cheung ◽

Barbara Haas ◽

Thom J. Ringer ◽

Amanda McFarlan ◽

Camilla L. Wong

Keyword(s):

Adverse Outcomes ◽

Geriatric Trauma ◽

Trauma Patients ◽

Canadian Study ◽

Clinical Frailty Scale

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A Geriatrics-Focused Hospitalist Trauma Comanagement Program Improves Survival and Quality Measures for Older Adults: A Propensity Score-Matched Analysis

10.21203/rs.3.rs-256284/v1 ◽

2021 ◽

Author(s):

Nasen J. Zhang ◽

Liron Sinvani ◽

Tung Ming Leung ◽

Michael Qiu ◽

Cristy L. Meyer ◽

...

Keyword(s):

High Risk ◽

Propensity Score ◽

Older Adult ◽

Quality Indicators ◽

Intervention Group ◽

Geriatric Trauma ◽

Categorical Variables ◽

Control Group ◽

Trauma Patients ◽

Medical Complexity

Abstract Background: Given the increasing age and medical complexity of trauma patients, medical comanagement has been adopted as a strategy for high-risk patients. This study aimed to determine whether a geriatrics-focused hospitalist trauma comanagement program improves outcomes.Methods: A pre- and post-implementation study compared older adult trauma patients who were comanaged by a hospitalist with those prior to comanagement at a Level 1 trauma center. Criteria for comanagement included: age 65+, multiple comorbidities, and use of high-risk medications. Comanagement focused on geriatric trauma management guidelines. One-to-one propensity score matching (PSM) was performed based on age, gender, Injury Severity Score, Charlson comorbidity index, and initial admission to the intensive care unit (ICU). Outcomes included hospital mortality, length of stay (LOS), and orders for geriatrics-focused quality indicators. Differences were compared with the Wilcoxon Rank Sum test for continuous variables and chi- square or Fisher’s exact test for categorical variables.Results: From 792 control and 365 intervention patients, PSM resulted in 290 matched pairs. Three intervention group patients died compared to 14 in the control group (p=0.0068). Hospital LOS, 30-day readmission, ICU LOS, and ICU upgrades were not significantly different between groups. There was an overall trend toward improved geriatrics-focused quality indicators in the intervention group. Intervention group was less likely to be restrained (p=0.04), received earlier physical therapy (p=0.01), more doses of acetaminophen compared to control patients (p<0.0001), and more subcutaneous enoxaparin rather than heparin (p=0.0027).Discussion: Our main findings highlight the higher medical complexity and increased risks in older adult trauma patients, as well as the mortality reduction and adherence increase to geriatrics-focused quality indicators. Limitations of our study included use of a single center, the possibility of selection bias in analyzing historical data, and a low sample size, all of which may limit generalizability. Conclusions: Our study demonstrates that a geriatrics-focused hospitalist trauma comanagement program improves survival and quality of care.

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Geriatric Trauma

DeckerMed Surgery ◽

10.2310/surg.2254 ◽

2019 ◽

Author(s):

Sigrid Burruss ◽

Lillian Min ◽

Areti Tillou

Keyword(s):

Risk Factors ◽

Care Coordination ◽

Unintentional Injury ◽

The Elderly ◽

Geriatric Trauma ◽

Trauma Patients ◽

Age Related ◽

Trauma Population ◽

Downward Spiral ◽

Risk Factors For Falls

The geriatric trauma population continues to grow as life expectancy and unintentional injury increase. Age-related physiologic changes and complex comorbidities may not only lead to injury but also may precipitate a downward spiral. The injury patterns, presentation of life-threatening injury, and response to injury are unique in the elderly trauma population, and dedicated evaluation of elderly trauma patients at a trauma center may be beneficial. Aggressive, early intervention with a focus on geriatric-specific needs and care coordination are an integral part of the management to reduce morbidity and mortality. Much of the unintentional injuries may be preventable with identification of risk factors for falls and fall prevention programs. Frailty measurements may be used to predict morbidity and functional status. Surgeons must become familiar with geriatric-specific issues and how best to treat the geriatric trauma population. This review contains 3 figures, 2 tables, and 133 references. Key Words: care coordination, elderly, frailty, geriatric, injury, prevention, risk factors, trauma, triage

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Suburban geriatric trauma: the experiences of a level I trauma center

American Journal of Critical Care ◽

10.4037/ajcc1995.4.5.379 ◽

1995 ◽

Vol 4 (5) ◽

pp. 379-382 ◽

Cited By ~ 9

Author(s):

F DeKeyser ◽

D Carolan ◽

A Trask

Keyword(s):

Trauma Center ◽

Functional Outcomes ◽

Injury Severity ◽

The Elderly ◽

Mortality Rates ◽

Geriatric Trauma ◽

Trauma Patients ◽

Younger Patients ◽

Severity Scores ◽

Trauma Scores

BACKGROUND: As the mean age of the US population increases, so does the incidence of geriatric trauma. Investigators have shown that the elderly have high morbidity and mortality rates associated with traumatic injuries. OBJECTIVE: To compare the severity of injury, mortality, and functional outcomes of geriatric patients with younger patients admitted to a suburban trauma center. METHOD: A convenience sample of trauma patients who were 65 years old or older was compared with trauma patients who were 35 to 45 and 55 to 64 years old. Demographic data, injury data, Injury Severity Scores, Revised Trauma Scores, length of stay, and functional ability outcomes were abstracted from a trauma registry in aggregate form and then analyzed. RESULTS: The sample consisted of 766 subjects (age 35-45, n = 223; age 55-64, n = 135; age 65 and older, n = 408) with a mean age of 64.6 years. A larger percentage of the elderly were victims of falls; younger trauma patients were more likely to be victims of motor vehicle crashes. Significant differences were found between age groups on Glasgow Coma Scale scores. Revised Trauma Scores, and length of stay. Significant differences were not found on Injury Severity Scores, mortality rates, or functional outcomes. CONCLUSIONS: Although anatomic injury severity of elderly patients was similar to that of younger patients, the elderly demonstrated greater physiologic compromise and longer hospital stays. Mortality rates were lower for the elderly group, but this result might be because a larger proportion of elderly patients were hospitalized with minor or moderate injuries.

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An increasing trend in geriatric trauma patients undergoing surgical stabilization of rib fractures

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01526-7 ◽

2020 ◽

Author(s):

William Duong ◽

Areg Grigorian ◽

Jeffry Nahmias ◽

Cyrus Farzaneh ◽

Ashton Christian ◽

...

Keyword(s):

Rib Fractures ◽

Geriatric Trauma ◽

Trauma Patients ◽

Increasing Trend

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Improvement in geriatric trauma outcomes in an evolving trauma system

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000282 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000282 ◽

Cited By ~ 7

Author(s):

Amund Hovengen Ringen ◽

Iver Anders Gaski ◽

Hege Rustad ◽

Nils Oddvar Skaga ◽

Christine Gaarder ◽

...

Keyword(s):

Trauma System ◽

Trauma Team ◽

The Elderly ◽

Geriatric Trauma ◽

Trauma Patients ◽

Age Group ◽

Trauma Team Activation ◽

Activation Rate ◽

Time Periods ◽

Activation Rates

BackgroundThe elderly trauma patient has increased mortality compared with younger patients. During the last 15 years, initial treatment of severely injured patients at Oslo University Hospital Ulleval (OUHU) has changed resulting in overall improved outcomes. Whether this holds true for the elderly trauma population needs exploration and was the aim of the present study.MethodsWe performed a retrospective study of 2628 trauma patients 61 years or older admitted to OUHU during the 12-year period, 2002–2013. The population was stratified based on age (61–70 years, 71–80 years, 81 years and older) and divided into time periods: 2002–2009 (P1) and 2010–2013 (P2). Multiple logistic regression models were constructed to identify clinically relevant core variables correlated with mortality and trauma team activation rate.ResultsCrude mortality decreased from 19% in P1 to 13% in P2 (p<0.01) with an OR of 0.77 (95 %CI 0.65 to 0.91) when admitted in P2. Trauma team activation rates increased from 53% in P1 to 72% in P2 (p<0.01) with an OR of 2.16 (95% CI 1.93 to 2.41) for being met by a trauma team in P2. Mortality increased from 10% in the age group 61–70 years to 26% in the group above 80 years. Trauma team activation rates decreased from 71% in the age group 61–70 years to 50% in the age group older than 80 years. Median ISS were 17 in all three age groups and in both time periods.DiscussionDevelopment of a multidisciplinary dedicated trauma service is associated with increased trauma team activation rate as well as survival in geriatric trauma patients. As expected, mortality increased with age, although inversely related to the likelihood of being met by a trauma team. Trauma team activation should be considered for all trauma patients older than 70 years.Level of evidenceLevel IV.

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