The DEPARTS Score: A Novel Tool for Predicting Discharge Disposition in Geriatric Trauma Patients

2021 ◽  
pp. 000313482110298
Author(s):  
Eric O. Yeates ◽  
Areg Grigorian ◽  
Catherine M. Kuza ◽  
Ninh T. Nguyen ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Acute Care ◽  
Weighted Average ◽  
Functional Health ◽  
Geriatric Trauma ◽  
Receiver Operating Curve ◽  
High Risk Population ◽  
Trauma Patients ◽  
Improvement Program ◽  
Discharge Disposition ◽  
Cord Injury

Background Geriatric trauma patients (GTPs) represent a high-risk population for needing post-acute care, such as skilled nursing facilities (SNFs) and long-term acute care hospitals (LTACs), due to a combination of traumatic injuries and baseline functional health. As there is currently no well-established tool for predicting these needs, we aimed to create a scoring tool that predicts disposition to SNFs/LTACs in GTPs. Methods The adult 2017 Trauma Quality Improvement Program database was divided at random into two equal sized sets (derivation and validation sets) of GTPs >65 years old. First, multiple logistic regression models were created to determine risk factors for discharge to a SNF/LTAC in admitted GTPs. Second, the weighted average and relative impact of each independent predictor was used to derive a DEPARTS ( Discharge of Elderly Patients After Recent Trauma to SNF/LTAC) score. We then validated the score using the area under the receiver-operating curve (AROC). Results Of 66 479 patients in the derivation set, 36 944 (55.6%) were discharged to a SNF/LTAC. Number of comorbidities, fall mechanism, spinal cord injury, long bone fracture, and major surgery were each independent predictors for discharge to SNF/LTAC, and a DEPARTS score was derived with scores ranging from 0 to 19. The AROC for this was .74. In the validation set, 66 477 patients also had a SNF/LTAC discharge rate of 55.7%, and the AROC was .74. Discussion The DEPARTS score is a good predictor of SNF/LTAC discharge for GTPs. Future prospective studies are warranted to validate its accuracy and clinical utility in preventing delays in discharge.

Insurance Status and Ethnicity Impact Health Disparities in Rates of Advance Directives in Trauma

2021 ◽  
pp. 000313482110111
Author(s):  
Krista L. Haines ◽  
Benjamin P. Nguyen ◽  
Ioana Antonescu ◽  
Jennifer Freeman ◽  
Christopher Cox ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
End Of Life ◽  
Hospice Care ◽  
Private Insurance ◽  
Future Research ◽  
Trauma Patients ◽  
Improvement Program ◽  
Advanced Directives ◽  
Logistic Regression Models ◽  
Discharge Disposition

Introduction Advanced directives (ADs) provide a framework from which families may understand patient’s wishes. However, end-of-life planning may not be prioritized by everyone. This analysis aimed to determine what populations have ADs and how they affected trauma outcomes. Methods Adult trauma patients recorded in the American College of Surgeons Trauma Quality Improvement Program (TQIP) from 2013-2015 were included. The primary outcome was presence of an AD. Secondary outcomes included mortality, length of stay (LOS), mechanical ventilation, ICU admission/LOS, withdrawal of life-sustaining measures, and discharge disposition. Multivariable logistic regression models were developed for outcomes. Results 44 705 patients were included in the analyses. Advanced directives were present in 1.79% of patients. The average age for patients with ADs was 77.8 ± 10.7. African American (odds ratio (OR) .53, confidence intervals [CI] .36-.79) and Asian (OR .22, CI .05-.91) patients were less likely to have ADs. Conversely, Medicaid (OR 1.70, CI 1.06-2.73) and Medicare (OR 1.65, CI 1.25-2.17) patients were more likely to have ADs as compared to those with private insurance. The presence of ADs was associated with increased hospital mortality (OR 2.84, CI 2.19-3.70), increased transition to comfort measures (OR 2.87, CI 2.08-3.95), and shorter LOS (CO −.74, CI −1.26-.22). Patients with ADs had an increased odds of hospice care (OR 4.24, CI 3.18-5.64). Conclusion Advanced directives at admission are uncommon, particularly among African Americans and Asians. The presence of ADs was associated with increased mortality, use of mechanical ventilation, admission to the ICU, withdrawal of life-sustaining measures, and hospice. Future research should target expansion of ADs among minority populations to alleviate disparities in end-of-life treatment.

Geriatric Trauma Screening Tool: Preinjury Functional Status Dictates Intensive Care Unit Discharge Disposition

2019 ◽  
Vol 85 (8) ◽  
pp. 800-805
Author(s):  
Lindsey C. Bridges ◽  
Amy B. Christie ◽  
Hamza H. Awad ◽  
Erika J. Sigman ◽  
D. Benjamin Christie ◽  
...  
Keyword(s):  
Older Adults ◽  
Functional Status ◽  
Screening Tool ◽  
Intensive Care Unit Discharge ◽  
Hospital Length ◽  
Transitions Of Care ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Discharge Disposition ◽  
Hospital Resources

Older adults account for an increasing percentage of trauma patients and have worse outcomes when compared with younger populations. Simple prediction tools are needed to designate risk categories among these patients. The Geriatric Trauma Screening Tool (GTST) was developed to risk stratify older adults admitted to the ICU at a Level 1 trauma center. One hundred fifty patients aged ≥ 65 years were prospectively screened for high-risk (HR) injuries, comorbidities, and pre-hospital function using the GTST. Patients who screened for HR were more likely to have an unfavorable disposition than non-HR patients. HR patients had significantly longer ICU and hospital length of stays when compared with non-HR patients. In addition, patients with prior functional impairment were at higher risk for an unfavorable discharge disposition than their counterparts. Implementation of the GTST predicted discharge disposition in geriatric trauma patients admitted to the ICU. Pre-injury functional status was a better predictor of discharge disposition than either the types of HR injuries or the presence of comorbidities. Risk stratification of geriatric trauma patients allows for early engagement of patients and caregivers regarding transitions of care as well as more efficient utilization of hospital resources.

Predicting Postoperative Complications for Acute Care Surgery Patients Using the ACS NSQIP Surgical Risk Calculator

2017 ◽  
Vol 83 (7) ◽  
pp. 733-738 ◽  
Author(s):  
Jessica R. Burgess ◽  
Benjamin Smith ◽  
Rebecca Britt ◽  
Leonard Weireter ◽  
Travis Polk
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Acute Care ◽  
Acute Care Surgery ◽  
High Risk Population ◽  
Risk Calculator ◽  
Improvement Program ◽  
Acs Nsqip ◽  
Care Surgery ◽  
Tract Infections

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator has been used to assist surgeons in predicting the risk of postoperative complications. This study aims to determine if the risk calculator accurately predicts complications in acute care surgical patients undergoing laparotomy. A retrospective review was performed on all patients on the acute care surgery service at a tertiary hospital who underwent laparotomy between 2011 and 2012. The preoperative risk factors were used to calculate the estimated risks of postoperative complications in both the original ACS NSQIP calculator and updated calculator (June 2016). The predicted rate of complications was then compared with the actual rate of complications. Ninety-five patients were included. Both risk calculators accurately predicted the risk of pneumonia, cardiac complications, urinary tract infections, venous thromboembolism, renal failure, unplanned returns to operating room, discharge to nursing facility, and mortality. Both calculators underestimated serious complications (26% vs 39%), overall complications (32.4% vs 45.3%), surgical site infections (9.3% vs 20%), and length of stay (9.7 days versus 13.1 days). When patients with prolonged hospitalization were excluded, the updated calculator accurately predicted length of stay. The ACS NSQIP risk calculator underestimates the overall risk of complications, surgical infections, and length of stay. The updated calculator accurately predicts length of stay for patients <30 days. The acute care surgical population represents a high-risk population with an increased rate of complications. This should be taken into account when using the risk calculator to predict postoperative risk in this population.

scholarly journals Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes

2019 ◽  
Vol 5 ◽  
pp. 233372141985873 ◽  
Author(s):  
Sumit Saha ◽  
Stephen M. DiRusso ◽  
Scott Welle ◽  
Benjamin Lieberman ◽  
Joel Sender ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Patient Discharge ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Outpatient Services ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Benefit Patient

Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (–67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.

Frailty Predicts Adverse Discharge Disposition in Geriatric Trauma Patients with Mild Traumatic Brain Injury

2020 ◽  
Vol 231 (4) ◽  
pp. e144
Author(s):  
Asad Azim ◽  
Muhammad Zeeshan ◽  
Kartik Prabhakaran ◽  
Rifat Latifi ◽  
Faisal S. Jehan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Discharge Disposition

Prehospital Variables Alone Can Predict Mortality After Blunt Trauma: A Novel Scoring Tool

2021 ◽  
pp. 000313482110241
Author(s):  
Stephen Stopenski ◽  
Areg Grigorian ◽  
Kenji Inaba ◽  
Michael Lekawa ◽  
Kazuhide Matsushima ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Vital Signs ◽  
Weighted Average ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Improvement Program ◽  
Logistic Regression Models ◽  
Revised Trauma Score ◽  
Activation Criterion ◽  
Scoring Tool

Background We sought to develop a novel Prehospital Injury Mortality Score (PIMS) to predict blunt trauma mortality using only prehospital variables. Study Design The 2017 Trauma Quality Improvement Program database was queried and divided into two equal sized sets at random (derivation and validation sets). Multiple logistic regression models were created to determine the risk of mortality using age, sex, mechanism, and trauma activation criterion. The PIMS was derived using the weighted average of each independent predictor. The discriminative power of the scoring tool was assessed by calculating the area under the receiver operating characteristics (AUROC) curve. The PIMS ability to predict mortality was then assessed by using the validation cohort. The score was compared to the Revised Trauma Score (RTS) using the AUROC curve, including a subgroup of patients with normal vital signs. Results The derivation and validation groups each consisted of 163 694 patients. Seven independent predictors of mortality were identified, and the PIMS was derived with scores ranging from 0 to 20. The mortality rate increased from 1.4% to 43.9% and then 100% at scores of 1, 10, and 19, respectively. The model had very good discrimination with an AUROC of .79 in both the derivation and validation groups. When compared to the RTS, the AUROC were similar (.79 vs. .78). On subgroup analysis of patients with normal prehospital vital signs, the PIMS was superior to the RTS (.73 vs. .56). Conclusion The PIMS is a novel scoring tool to predict mortality in blunt trauma patients using prehospital variables. It had improved discriminatory power in blunt trauma patients with normal vital signs compared to the RTS.

Predicting hospital discharge disposition in geriatric trauma patients

2014 ◽  
Vol 76 (1) ◽  
pp. 196-200 ◽  
Author(s):  
Bellal Joseph ◽  
Viraj Pandit ◽  
Peter Rhee ◽  
Hassan Aziz ◽  
Moutamn Sadoun ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Discharge Disposition

Multidisciplinary Patient Management Improves Mortality in Geriatric Trauma Patients

2019 ◽  
Vol 85 (2) ◽  
pp. 230-233 ◽  
Author(s):  
Joseph Losh ◽  
Thomas K. Duncan ◽  
Graal Diaz ◽  
Hyesun Lee ◽  
Javier Romero
Keyword(s):  
Quality Improvement ◽  
Medical Center ◽  
Injured Patient ◽  
Primary Objective ◽  
Quality Improvement Program ◽  
Geriatric Trauma ◽  
Collaborative Management ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Medicine

Improvement in the care of the traumatically injured patient should be a goal at all trauma centers. One purpose of the data generated by the Trauma Quality Improvement Program is to provide insight which will lead to quality improvement initiatives and to promote intrinsic improvement on a center by center basis. The primary objective of this study was to measure the efficacy of instituting a multidisciplinary Trauma Medicine (T-MED) program to improve geriatric mortality at Ventura County Medical Center (VCMC). Trauma Quality Improvement Program data at VCMC before October 2013 demonstrated poor performance in treating geriatric patients. To attempt to improve outcomes, a multidisciplinary T-MED program was instituted in October 2013, which included a mandatory consultation and collaborative management with hospitalist medicine physicians for all trauma patients 65 years of age or older. The T-MED program increased focus on preexisting conditions, medication management, and discharge planning, including rehabilitation and continuity of care. Institution of a T-MED program at VCMC resulted in significant improvement in mortality rates for geriatric trauma patients.

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