Application of a Geriatric Injury Protocol Demonstrates High Survival Rates for Geriatric Trauma Patients with High Injury Acuity

Abstract

Geriatric trauma has historically been associated with poor outcomes, particularly in the setting of severe polytrauma. Although geriatric trauma protocols are common, there are limited data on their impact in patients with high injury severity. In this study, we sought to investigate the impact of a geriatric injury protocol on outcomes in patients with severe trauma acuity. Ninety-eight geriatric patients (age ≥65) admitted to our trauma center with injury severity scores (ISS) ≥15 comprised the study cohort. The mean age was 75 ± 7.7 yrs. The mean ISS was 25 ± 9.2, and the mean geriatric trauma outcome score was 150 ± 3. Mortality was 17 per cent and 70 per cent were due to central nervous system injury. When patients with nonsurvivable injuries or advanced directives resulting in early care withdrawal were excluded, the mortality was 6 per cent. Extremes of age did not impact mortality [(>80 years, 21%) vs (65–79, 16%, P = 0.5)]. Most patients (53%) were discharged home. The application of our geriatric trauma protocol led to favorable results despite high injury acuity. These data suggest that even at the extremes of age, a large percentage of patients can be expected to survive. A prospective validation of these findings is warranted.

Models of Care in Geriatric Intensive Care—A Scoping Review on the Optimal Structure of Care for Critically Ill Older Adults Admitted in an ICU

“…Two descriptive cohort studies without a comparator group described the impact of implementing protocols in a medical ICU ( 26 ) older adult population, and trauma and surgical ICU ( 25 ) older adult population. Aspects of these protocols included anticoagulation reversal, rib fracture management, and avoidance of benzodiazepines.…”

“…Four (21%) articles were pre-post intervention cohort studies (17)(18)(19)(20), eight (42%) were descriptive cohort studies without a comparator group (21)(22)(23)(24)(25)(26)(27)(28), and seven (37%) were editorials, reviews, and opinion pieces (29-35) (Supplementary Tables 1 and 2, http://links. lww.com/CCX/A969).…”

“…Four different models of care were identified (Table 1): dedicated geriatric beds (17,20,23,24,28,33), geriatric assessment by a geriatrician (18,19,21,27), geriatric assessment without geriatrician (22,29,34,35), and other approaches. Other approaches included checklists, bundles of care, and incremental educational strategies (25,26,(30)(31)(32). The four models were distinguished by the specified environment (e.g., dedicated or nondedicated beds), the medical team expertise (e.g., presence or not of a geriatrician or intensivist), the nonmedical team expertise, and the intervention types.…”

The impact of interdisciplinary care on cost reduction in a geriatric trauma population

“…[ 7 ] and Karamanukyan et al . [ 8 ] recently showed that the use of geriatric trauma care multidisciplinary protocols can improve patient care. It is evident that a multidisciplinary approach to geriatric trauma can improve patient outcomes, yet such comprehensive services may lead to increased health-care expenditures.…”

“…Multidisciplinary care of geriatric trauma patients either through dedicated geriatric units or hospital pathways has been reported to improve inpatient outcomes. [ 7 8 9 10 ] Although these data are promising, the cost-effectiveness of such programs remains to be elucidated. To date, there are few studies that have focused on the sustainability/cost-effectiveness of a specialized geriatric trauma program.…”