A Model of Care to Improve Survival of Older Trauma Patients: Geriatrics Comanagement

Abstract

Background Trauma patients older than 80 years of age have higher mortality rates compared to younger peers. No studies have investigated the effectiveness of geriatrics co-management on mortality in general trauma. Methods Retrospective cohort study from 2015-2016 comparing overall and inpatient mortality in a geriatrics trauma co-management (GTC) program versus usual care (UC). Demographic and outcome measures were obtained from the trauma registry at an 11-bed trauma critical care unit within a 719-bed Level 1 Trauma Center. 1,572 patients, 80 years and older, with an admitting trauma diagnosis were evaluated. Primary outcome was in-hospital mortality and overall mortality (defined as inpatient death or discharge to hospice). Secondary outcomes included hospital length of stay (LOS), Intensive Care Unit (ICU) LOS, discharge location, and medical complications. Results 346 patients (22%) were placed in the GTC program. Overall mortality was lower in the GTC (4.9%) when compared with UC (11.9%), representing a 57% reduction (95% OR CI 0.24-0.75, p-value = 0.0028). There was a 7.42% hospital mortality rate in the UC group compared to 2.6% in the GTC group (95% CI 0.21-0.92, p-value = 0.0285) representing a 56% decrease in in-hospital mortality. GTC patients had a longer mean LOS (6.4 days versus 5.3 days, p-value <0.0001). More GTC patients were sent to inpatient rehabilitation facilities or skilled nursing facilities (80% versus 60%, p-value <0.0001). Conclusions Geriatrics trauma co-management of trauma patients above the age of 80 may reduce mortality and deserves formal study.

Rib Fracture Management in Older Adults: A Scoping Review

“…The involvement of a geriatrician in a trauma service to co-manage patients with multiple rib fractures has shown mortality benefits in patients greater than 80 years old. 46 Superiorly located rib fractures represent more intense trauma to the chest and are associated with cardiac and great vessel injury whereas inferior ribs risk splenic and liver laceration which might require assistance from subspecialties including interventional radiology. 47 Rib fractures take approximately 12 weeks to heal and patients typically regain up to 84% of their expected forced vital capacity, but it may be longer for older adults with underlying osteoporosis.…”

Impact of an opioid use disorder consult service on hospitalized trauma patients with opioid use disorder

“…In addition, shared management among different medical specialties in the care of trauma patients with specific risk factors or comorbidities has been shown to improve outcomes for trauma patients. Geriatrician comanagement in elderly patients presenting with traumatic injury has been shown to decrease mortality, as well as improve rates of discharge directly to home 12,13 . The involvement of a designated, internal medicine-trained “trauma hospitalist” in a trauma team has also been shown to decrease mortality and readmission rates in medically complex patients 14 .…”

“…Geriatrician comanagement in elderly patients presenting with traumatic injury has been shown to decrease mortality, as well as improve rates of discharge directly to home. 12,13 The involvement of a designated, internal medicinetrained "trauma hospitalist" in a trauma team has also been shown to decrease mortality and readmission rates in medically complex patients. 14 More specific to addiction, the inclusion of a psychiatrist on trauma rounds resulted in a 10% increase in psychiatry consults for trauma patients with substance use disorders such as OUD.…”