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

2017 ◽  
Vol 225 (5) ◽  
pp. 658-665.e3 ◽  
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

scholarly journals Malnutrition and its effects in severely injured trauma patients

2020 ◽  
Vol 46 (5) ◽  
pp. 993-1004 ◽  
Author(s):  
Suzan Dijkink ◽  
Karien Meier ◽  
Pieta Krijnen ◽  
D. Dante Yeh ◽  
George C. Velmahos ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Trauma Population ◽  
Injured Patients

Abstract Purpose In hospitalized patients, malnutrition is associated with adverse outcomes. However, the consequences of malnutrition in trauma patients are still poorly understood. This study aims to review the current knowledge about the pathophysiology, prevalence, and effects of malnutrition in severely injured patients. Methods A systematic literature review in PubMed and Embase was conducted according to PRISMA-guidelines. Results Nine review articles discussed the hypermetabolic state in severely injured patients in relation to malnutrition. In these patients, malnutrition negatively influenced the metabolic response, and vice versa, thereby rendering them susceptible to adverse outcomes and further deterioration of nutritional status. Thirteen cohort studies reported on prevalences of malnutrition in severely injured patients; ten reported clinical outcomes. In severely injured patients, the prevalence of malnutrition ranged from 7 to 76%, depending upon setting, population, and nutritional assessment tool used. In the geriatric trauma population, 7–62.5% were malnourished at admission and 35.6–60% were at risk for malnutrition. Malnutrition was an independent risk factor for complications, mortality, prolonged hospital length of stay, and declined quality of life. Conclusions Despite widespread belief about the importance of nutrition in severely injured patients, the quantity and quality of available evidence is surprisingly sparse, frequently of low-quality, and outdated. Based on the malnutrition-associated adverse outcomes, the nutritional status of trauma patients should be routinely and carefully monitored. Trials are required to better define the optimal nutritional treatment of trauma patients, but a standardized data dictionary and reasonable outcome measures are required for meaningful interpretation and application of results.

scholarly journals Central Obesity Is a Predictor of Stress Hyperglycemia in Critically Ill Geriatric Trauma Patients (P21-051-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Anna Ssentongo ◽  
Paddy Ssentongo ◽  
Scott Armen ◽  
David Soybel ◽  
John Oh
Keyword(s):  
Waist Circumference ◽  
Visceral Fat ◽  
Central Obesity ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Visceral Fat Area ◽  
Future Outcomes

Abstract Objectives In the elderly population, hyperglycemia is associated with increased rates of infections, length of hospital stay (LOS) and mortality. However, there is a lack of informative studies addressing the drivers of hyperglycemia. We hypothesized that central obesity has an effect on hyperglycemia. Therefore, our objective is to investigate whether central obesity predicts hyperglycemia within the first 48 hours of admission in elderly trauma patients admitted to the ICU. Methods Our trauma registry was queried for all trauma patients aged 65 and older from 2012 to 2018 with an intensive care unit (ICU) LOS of at least 3 days. CT scan images were reviewed for visceral fat area, waist circumference to height ratio (WCHR), waist circumference to hip ratio (WHR) and the presence of sarcopenia, which has been implicated in adverse outcomes of trauma, in the presence or absence of obesity. Results Of 320 elderly patients, 7% developed infections, 3% developed stroke, 52% had an increased ICU LOS >6 days, and 48% had an increased total hospital LOS >14 d. The prevalence of sarcopenia was 26%, increased visceral fat area >200 cm2 was 87%, WCHR >0.65 was 25%, and WHR >1 was 54% All of these factors except sarcopenia were significant predictors of hyperglycemia >140 mg/dL (OR: 4.0, 95% CI: 2.53–6.46), (OR: 2.45, 95% CI: 1.47–4.16) and (OR: 3.1, 95% CI: 1.93–4.9) respectively. A total of 143 patients (45%) had an average glucose >140 mg/dL within the first 48 hours after admission and this was independently associated with infections (OR: 2.64, 95% CI: 1.06–7.13), stroke (OR: 5.88, 95% CI: 1.48–38.96), increased ICU LOS (OR: 1.87, 95% CI: 1.20–2.94) and increased hospital LOS (OR: 1.59, 95% CI: 1.02–2.48). Conclusions Central obesity independently predicts hyperglycemia in geriatric trauma patients. The influence of metabolic stressors related to adiposity may drive elevated glucose levels and could represent a novel target for future outcomes studies in geriatric critical illness Funding Sources None.

scholarly journals Making your geriatric and palliative programs a strength: TQIP guideline implementation and the VRC perspective

2021 ◽  
Vol 6 (1) ◽  
pp. e000677
Author(s):  
Vanessa P Ho ◽  
Sasha D Adams ◽  
Kathleen M O'Connell ◽  
Christine S Cocanour ◽  
Saman Arbabi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Best Practice ◽  
Guideline Implementation ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Best Practice Guidelines ◽  
American College Of Surgeons ◽  
Specialized Care ◽  
The Usa

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

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

2016 ◽  
Vol 81 (6) ◽  
pp. 1150-1155 ◽  
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

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

2016 ◽  
Vol 212 (1) ◽  
pp. 109-115 ◽  
Author(s):  
Tabitha Garwe ◽  
Roxie M. Albrecht ◽  
Julie A. Stoner ◽  
Stephanie Mitchell ◽  
Prasenjeet Motghare
Keyword(s):  
Geriatric Trauma ◽  
Trauma Patients

scholarly journals Validation of the Chinese-Canadian study of health and aging clinical frailty scale (CSHA-CFS) telephone version

2010 ◽  
Vol 50 (3) ◽  
pp. e74-e80 ◽  
Author(s):  
Ding-Cheng (Derrick) Chan ◽  
Hsiao-Hui Tsou ◽  
Chin-Ying Chen ◽  
Ching-Yu Chen
Keyword(s):  
Canadian Study ◽  
Clinical Frailty Scale ◽  
Chinese Canadian

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

2018 ◽  
Vol 268 (3) ◽  
pp. 534-540 ◽  
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

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

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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