Reliability of Mortality-based Geriatric Trauma Center Benchmarking: Do We Have Enough Patient Volumes To Accurately Compare Centers?

2014 ◽  
Vol 186 (2) ◽  
pp. 512
Author(s):  
Z.G. Hashmi ◽  
S.N. Zafar ◽  
J.B. Dimick ◽  
P.C. Jenkins ◽  
M.R. Hemmila ◽  
...  
Keyword(s):  
Trauma Center ◽  
Geriatric Trauma ◽  
Geriatric Trauma Center

scholarly journals Care of Geriatric Patients with Lumbar Spine, Pelvic, and Acetabular Fractures before and after Certification as a Geriatric Trauma Center DGU®: A Retrospective Cohort Study

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 794
Author(s):  
Tobias Hafner ◽  
Alina Kollmeier ◽  
Markus Laubach ◽  
Matthias Knobe ◽  
Frank Hildebrand ◽  
...  
Keyword(s):  
Cohort Study ◽  
Lumbar Spine ◽  
Patient Care ◽  
Geriatric Assessment ◽  
Trauma Center ◽  
Geriatric Patients ◽  
Geriatric Trauma ◽  
Acetabular Fractures ◽  
Geriatric Trauma Center ◽  
Before And After

Background: More than 750,000 fragility fractures occur in Germany every year, with an expected increase in the following years. Interdisciplinary care pathways for geriatric patients are increasingly established to improve the treatment process and outcome, but there has been only limited evaluation of their use. Objectives: This study aimed to compare patient care before and after the implementation of a geriatric trauma center (GTC) in conformity with the German Society for Trauma Surgery (DGU®). Patients and Methods: We performed a retrospective single-center cohort study, including 361 patients > 70 years old with lumbar spine, pelvic, and acetabular fractures, admitted between January 2012 and September 2019. Patients were divided into a usual care cohort (UC, n = 137) before implementation and an ortho-geriatric care cohort (OGC, n = 224) after implementation of the GTC DGU®. We recorded and compared demographic data, fracture type, geriatric assessment and management, therapy, complications, and various clinical parameters, e.g., length of stay, time to surgery, hours admitted to ICU, and change in walking ability. Results: The geriatric assessment revealed significant geriatric co-morbidities and a need for geriatric intervention in 75% of the patients. With orthogeriatric co-management, a significant increase in the detection of urological complications (UC: 25.5% vs. OGC: 37.5%; p = 0.021), earlier postoperative mobilization (UC: 57.1% vs. OGC: 86.3%; p < 0.001), an increased prescription of anti-osteoporotic treatment at discharge (UC: 13.1% vs. OGC: 46.8%; p < 0.001), and lower rates of revision surgery (UC: 5.8% vs. OGC: 3.1%; p = 0.012) could be seen. Conclusions: Our results emphasize the improvement in patient care and clinical outcome by implementing a GTC DGU® and provide opportunities for future improvement in ortho-geriatric patient care.

scholarly journals The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244554
Author(s):  
Sascha Halvachizadeh ◽  
Lea Gröbli ◽  
Till Berk ◽  
Kai Oliver Jensen ◽  
Christian Hierholzer ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Trauma Center ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Complication Rates ◽  
Geriatric Trauma Center ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact ◽  
Group Post

Introduction Improvements in life expectancy imply that an increase of geriatric trauma patients occurs. These patients require special attention due to their multiple comorbidity issues. The aim of this study was to assess the impact of the implementation of geriatric comanagement (GC) on the allocation and clinical outcome of geriatric trauma patients. Methods This observational cohort study aims to compare the demographic development and the clinical outcome in geriatric trauma patients (aged 70 years and older) before and after implementation of a certified geriatric trauma center (GC). Geriatric trauma patients admitted between January 1, 2010 and December 31, 2010 were stratified to group pre-GC and admissions between January 1, 2018 and December 31, 2018 to Group post-GC. We excluded patients requiring end-of-life treatment and those who died within 24 h or due to severe traumatic brain injury. Outcome parameters included demographic changes, medical complexity (measured by American Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index (CCI)), in-hospital mortality and length of hospitalization. Results This study includes 626 patients in Group pre-GC (mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age 81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC and 5.1 (± 2.0) points in post-GC (p <0.001). In Group pre-GC, 100 patients (16.0%) were stratified as ASA 1 compared with 47 patients (5.6%) in Group post-GC (p <0.001). Group pre-GC had significantly less patients stratified as ASA 3 or higher (n = 235, 37.5%) compared with Group post-GC (n = 389, 46.3%, p <0.001). Length of stay (LOS) decreased significantly from 10.4 (± 20.3) days in Group pre-GC to 7.9 (±22.9) days in Group post-GC (p = 0.011). The 30-day mortality rate was comparable amongst these groups (pre-GC 8.8% vs. post-GC 8.9%). Conclusion This study appears to support the implementation of a geriatric trauma center, as certain improvements in the patient care were found: Despite a higher CCI and a higher number of patients with higher ASA classifications, Hospital LOS, complication rates and mortality did were not increased after implementation of the CG. The increase in the case numbers supports the fact that a higher degree of specialization leads to a response by admitting physicians, as it exceeded the expectable trend of demographic ageing. We feel that a larger data base, hopefully in a multi center set up should be undertaken to verify these results.

scholarly journals Mortality profile of geriatric trauma at a level 1 trauma center

2020 ◽  
Vol 13 (4) ◽  
pp. 269
Author(s):  
Chhavi Sawhney ◽  
Sanjeev Lalwani ◽  
Sakshi Gera ◽  
Purva Mathur ◽  
Parin Lalwani ◽  
...  
Keyword(s):  
Trauma Center ◽  
Geriatric Trauma ◽  
Level 1 ◽  
Level 1 Trauma Center

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

1995 ◽  
Vol 4 (5) ◽  
pp. 379-382 ◽  
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.

The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan

2019 ◽  
Vol 34 (05) ◽  
pp. 497-505
Author(s):  
Matthew H. Meyers ◽  
Trent L. Wei ◽  
Julianne M. Cyr ◽  
Thomas M. Hunold ◽  
Frances S. Shofer ◽  
...  
Keyword(s):  
Older Adults ◽  
Trauma Center ◽  
Medical Information ◽  
Geriatric Trauma ◽  
Medical Information System ◽  
Trauma Patients ◽  
Glascow Coma Scale ◽  
Serious Injury ◽  
Gcs Score ◽  
The Impact

AbstractIntroduction:In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.Hypothesis/Problem:The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.Methods:This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.Results:The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure &lt;90 mmHg (22.5% versus 23.5%); respiratory rate &lt;10 or &gt;29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score &lt;13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.Conclusions:State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.

The Prevalence of Beers Criteria Medication Use and Associations with Falls in Geriatric Patients at a Level 1 Trauma Center

2019 ◽  
Vol 85 (8) ◽  
pp. 877-882 ◽  
Author(s):  
Benjamin S. Walker ◽  
Bryan R. Collier ◽  
Katie L. Bower ◽  
Daniel I. Lollar ◽  
Emily R. Faulks ◽  
...  
Keyword(s):  
Trauma Center ◽  
Fall Risk ◽  
Medication Reconciliation ◽  
Geriatric Patients ◽  
Medication Use ◽  
Geriatric Trauma ◽  
Beers Criteria ◽  
Trauma Patients ◽  
Level 1 ◽  
Level 1 Trauma Center

The Beers Criteria for Potentially Inappropriate Medication (PIM) use is a list of medications with multiple risks in older patients. Approximately 24 per cent use rate is reported in prior studies. Our objective was to determine the local PIM use and subsequent fall risk in geriatric trauma patients. We conducted a retrospective analysis of PIM use in all geriatric patients evaluated at our Level 1 trauma center between 2014 and 2017. Patients were identified from our trauma database. Pre-admission medication use was determined through medication reconciliation from our electronic medical record (EMR). Patients not undergoing medication reconciliation were excluded. After initial analysis, patients were stratified by age into three groups: 65 to 74, 75 to 84, and ≥85 years. Multivariate logistic regression analyses were used to calculate odds ratios of falls for specific PIMs. In all, 2181 patients met the inclusion criteria. Overall, 71.2 per cent of geriatric trauma patients were prescribed at least one PIM—73.1 per cent of falls compared with 68.6 per cent for other mechanisms. Specific PIM use varied by age group. PIMs associated with fall risk in all patients included antipsychotics, benzodiazepines, and diclofenac. For those aged 65 to 74 years, antihistamines, diclofenac, proton pump inhibitors, and promethazine were associated. In those aged 75 to 84 years, alprazolam, antipsychotics, benzodiazepines, cyclobenzaprine, diclofenac, and muscle relaxants were implicated. No significant associations were found for patients aged ≥85 years. PIM use at our trauma center seems to be rampant and well above the national average. Geriatric falls were associated with using ≥1 PIM and multiple specific PIMs implicated. We are designing a targeted educational program for local primary care physicians (PCPs) that will attempt to decrease geriatric PIM use.

Geriatric Trauma Patients at a Suburban Level-I Trauma Center in Japan

1999 ◽  
Vol 14 (3) ◽  
pp. 79-83 ◽  
Author(s):  
Katsuhiko Sugimoto ◽  
Toru Aruga ◽  
Mitsuhiro Hirata ◽  
Masateru Shindo
Keyword(s):  
Mortality Rate ◽  
Emergency Medical Services ◽  
Trauma Center ◽  
Geriatric Trauma ◽  
Control Group ◽  
Trauma Patients ◽  
Direct Transfer ◽  
Emergency Center ◽  
Revised Trauma Score ◽  
Trauma Score

AbstractBackground:Despite the increases in the aged population in Japan, there are little data on geriatric patients with traumatic injuries. A prospective clinical study was carried out to evaluate the use of the emergency medical services (emergency medical services) system, mechanisms of injury, and prehospital assessment and triage of elderly victims of trauma.Patients and Methods:From July 1996 through June 1997, a group of geriatric trauma (Group G, n = 22) and a control group of younger trauma patients (n = 173) were compared with respect to transfer method to an Emergency Center (direct or indirect), Revised Trauma Scores on the scene of the accident (revised trauma score-l) and on admission to the Emergency Center (revised trauma score-2), and outcome (survival).Results:The mean values for revised trauma score-l in the Control Group (Group C) were not different from those in Group G, but revised trauma score-2 of the indirect-transfer patients (indirectly transported patients) in Group G were significantly lower than were those for Group C. Group G mortality rates were significantly higher than were the control rates (p = 0.0001). The mortality rate of the indirectly transported patients subgroup was significantly lower than that of the direct transfer subgroup (directly transported patients) (30/68 vs. 5/70, p<0.0001) in the Group C, but mortality rate of the indirectly transported patients subgroup exceeded that of the directly transported patients subgroup of Group G (8/14 vs. 5/8).Conclusion:The data suggest that in geriatric-age patients, direct transfer patients have a lower mortality rate than do indirect transfer patients when controlled for injury severity score. Therefore, it seems that a different set of triage criteria should be developed and implemented for geriatric-age victims with trauma-induced injuries and that those who meet these more stringent criteria should be transferred directly to a Trauma Center.

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