scholarly journals A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs

2013 ◽  
Vol 21 (1) ◽  
pp. 7 ◽  
Author(s):  
Kristin M Salottolo ◽  
Charles W Mains ◽  
Patrick J Offner ◽  
Pamela W Bourg ◽  
David Bar-Or
Keyword(s):  
Retrospective Analysis ◽  
Vital Signs ◽  
Geriatric Trauma ◽  
Trauma Patients

scholarly journals Retrospective Analysis of Geriatric Major Trauma Patients Admitted in the Shock Room of a Swiss Academic Hospital: Characteristics and Prognosis

2020 ◽  
Vol 9 (5) ◽  
pp. 1343
Author(s):  
Monica Pagin ◽  
Cédric Mabire ◽  
Michael Cotton ◽  
Tobias Zingg ◽  
Pierre-Nicolas Carron
Keyword(s):  
Mortality Rate ◽  
Retrospective Analysis ◽  
Major Trauma ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Main Diagnosis ◽  
Statistical Regression ◽  
Specific Patient ◽  
Anti Platelet Therapy ◽  
Main Factors

Increased life expectancy exposes a great number of elderly people to serious accidents, thus increasing the amount of major geriatric trauma cases. The aim of our study was to determine the profile of elderly patients undergoing major trauma, and the contributing factors predicting mortality in this specific patient group, compared to the younger population. Retrospective analysis of 1051 patients with major trauma admitted over ten years in a Level-1 trauma center was performed. Data collected were: history, nature and type of trauma; age and sex; vital signs on admission; injury severity score; shock index; comorbidities; coagulation diathesis; injury patterns; emergency measures taken; main diagnosis; mortality; and length of hospital and intensive care unit (ICU) stay. Geriatric patients admitted for major trauma have a mortality rate almost four times greater (47%) than their younger counterparts (14%) with the same ISS. According to statistical regression analysis, anti-platelet therapy (OR 3.21), NACA (National Advisory Committee for Aeronautics) score (OR 2.23), GCS (OR 0.83), ISS (OR 1.07) and age (OR 1.06) are the main factors predicting mortality. Conclusion: Geriatric major trauma patients admitted to our trauma resuscitation area have a high mortality rate. Age, GCS, ISS and NACA scores as well as anti-platelet therapy are the main factors predicting mortality.

Vital Signs Strongly Predict Massive Transfusion Need in Geriatric Trauma Patients

2016 ◽  
Vol 82 (7) ◽  
pp. 632-636 ◽  
Author(s):  
Scott C. Fligor ◽  
Mark E. Hamill ◽  
Katie M. Love ◽  
Bryan R. Collier ◽  
Dan Lollar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Massive Transfusion ◽  
Early Recognition ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Trauma Team ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Geriatric Population

Early recognition of massive transfusion (MT) requirement in geriatric trauma patients presents a challenge, as older patients present with vital signs outside of traditional thresholds for hypotension and tachycardia. Although many systems exist to predict MT need in trauma patients, none have specifically evaluated the geriatric population. We sought to evaluate the predictive value of presenting vital signs in geriatric trauma patients for prediction of MT. We retrospectively reviewed geriatric trauma patients presenting to our Level I trauma center from 2010 to 2013 requiring full trauma team activation. The area under the receiver operating characteristic curve was calculated to assess discrimination of arrival vital signs for MT prediction. Ideal cutoffs with high sensitivity and specificity were identified. A total of 194 patients with complete data were analyzed. Of these, 16 patients received MT. There was no difference between the MT and non-MT groups in sex, age, or mechanism. Systolic blood pressure, pulse pressure, diastolic blood pressure, and shock index all were strongly predictive of MT need. Interestingly, we found that heart rate does not predict MT. MT in geriatric trauma patients can be reliably and simply predicted by arrival vital signs. Heart rate may not reflect serious hemorrhage in this population.

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

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

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 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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