Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines

Southerland, Lauren T.; Gure, Tanya R.; Ruter, Daniel; Li, Michael M.; Evans, David C.

doi:10.1016/j.jss.2017.03.023

Cited by 35 publications

(31 citation statements)

References 25 publications

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“…27 Additionally, early consultation to a geriatric specialist has been shown to correlate with high rates of adherence to these guidelines. 28 Other studies have examined predictors of mortality in the elderly with aims of building a tool to predict those at high risk of death. 29 In this study, we quantify the relationship of in-hospital complications to mortality and demonstrate that both age and Injury Severity Score, both alone and synergistically, impact mortality, and that this result is compounded by any in-hospital complication.…”

Section: Discussionmentioning

confidence: 99%

Failure to Rescue in Geriatric Trauma: The Impact of Any Complication Increases with Age and Injury Severity in Elderly Trauma Patients

Stonko

Etchill

Giuliano

et al. 2021

The American Surgeon

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Introduction The interaction of increasing age, Injury Severity Score (ISS), and complications is not well described in geriatric trauma patients. We hypothesized that failure to rescue rate from any complication worsens with age and injury severity. Methods The National Trauma Data Bank (NTDB) was queried for injured patients aged 65 years or older from January 1, 2013 through December 31, 2016. Demographics and injury characteristics were used to compare groups. Mortality rates were calculated across subgroups of age and ISS, and captured with heatmaps. Multivariable logistic regression was performed to identify independent predictors of mortality. Results 614,496 geriatric trauma patients were included; 151,880 (24.7%) experienced a complication. Those with complications tended to be older, female, non-white, have non-blunt mechanism, higher ISS, and hypotension on arrival. Overall mortality was highest (19%) in the oldest (≥86 years old) and most severely injured (ISS ≥ 25) patients, with constant age increasing across each ISS group was associated with a 157% increase in overall mortality ( P < .001, 95% CI: 148-167%). Holding ISS stable, increasing age group was associated with a 48% increase in overall mortality ( P < .001, 95% CI: 44-52%). After controlling for standard demographic variables at presentation, the existence of any complication was an independent predictor of overall mortality in geriatric patients (OR: 2.3; 95% CI: 2.2-2.4). Conclusions Any complication was an independent risk factor for mortality, and scaled with increasing age and ISS in geriatric patients. Differences in failure to rescue between populations may reflect critical differences in physiologic vulnerability that could represent targets for interventions.

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Section: Discussionmentioning

confidence: 99%

Failure to Rescue in Geriatric Trauma: The Impact of Any Complication Increases with Age and Injury Severity in Elderly Trauma Patients

Stonko

Etchill

Giuliano

et al. 2021

The American Surgeon

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“…Clinical practice guidelines aim to support clinicians to make informed decisions about appropriate care, and there is evidence to suggest the standardisation of care of older major trauma patients improves outcomes [ 42 , 43 ]. The physiological, psychological and social changes associated with ageing require specialised integrated care for older people and in the UK this has been repeatedly highlighted in professional and clinical guidelines [ 1 , 13 , 44 ]. Whilst this survey provides evidence of pathways and protocols for older people’s trauma care being in place, the challenges moving forward are to identify which of the available guidance impacts positively on experience and outcome, and to validate patient centred outcomes for this population of patients.…”

Section: Discussionmentioning

confidence: 99%

Provision of acute care pathways for older major trauma patients in the UK

et al. 2022

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Background The introduction of specific pathways of care for older trauma patients has been shown to decrease hospital length of stay and the overall rate of complications. The extent and scope of pathways and services for older major trauma patients in the UK is not currently known. Objective The primary objective of this study was to map the current care pathways and provision of services for older people following major trauma in the UK. Methods A cross-sectional survey of UK hospitals delivering care to major trauma patients (major trauma centres and trauma units). Data were collected on respondent and site characteristics, and local definitions of older trauma patients. To explore pathways for older people with major trauma, four clinical case examples were devised and respondents asked to complete responses that best illustrated the admission pathway for each. Results Responses from 56 hospitals were included in the analysis, including from 25 (84%) of all major trauma centres (MTCs) in the UK. The majority of respondents defined ‘old’ by chronological age, most commonly patients 65 years and over. The specialty team with overall responsibility for the patient in trauma units was most likely to be acute medicine or acute surgery. Patients in MTCs were not always admitted under the care of the major trauma service. Assessment by a geriatrician within 72 hours of admission varied in both major trauma centres and trauma units and was associated with increased age. Conclusions This survey highlights variability in the admitting specialty team and subsequent management of older major trauma patients across hospitals in the UK. Variability appears to be related to patient condition as well as provision of local resources. Whilst lack of standardisation may be a result of local service configuration this has the potential to impact negatively on quality of care, multi-disciplinary working, and outcomes.

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“…[24] Improved documentation of code status, medications, and pre-injury level of care was associated with implementation of a combined geriatrics/trauma collaborative team in another recent investigation. [25] Few evaluations of geriatrics consultation have investigated in-hospital morbidity specifically. In the older adult population where patients and families may focus on quality (as opposed to quantity) of life, measures that prevent in-hospital complications may be a more meaningful measure of success compared to in-hospital or 30-day survival.…”

Section: Discussionmentioning

confidence: 99%

Complications in low-risk older adult trauma patients: A case-control study

Tessler

Rangel

Rosser

et al. 2019

J Trauma Acute Care Surg

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Background: Although some geriatric trauma patients may be low-risk for complications, poor outcomes are pronounced if complications do occur. Prevention in this group decreases the risk of excess morbidity and mortality. Methods: We performed a case-control study of trauma patients 65 years or older treated from January 2015 to August 2016 at a level I trauma center with a Trauma Quality Improvement Program (TQIP) predicted probability of complication < 20%. Cases had one of the following complications: unplanned admission to the intensive care unit (ICU), unplanned intubation, pneumonia, or unplanned return to the operating room. Two age-matched controls were randomly selected for each case. We collected information on comorbidities, home medications, and early medical care and calculated odds ratios using multivariable conditional logistic regression. Results: Ninety-four patients experienced unplanned admission to ICU (N=51), unplanned intubation (N=14), pneumonia (N=21), and unplanned return to OR (N=8). The 188 controls were

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Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines

Cited by 35 publications

References 25 publications

Failure to Rescue in Geriatric Trauma: The Impact of Any Complication Increases with Age and Injury Severity in Elderly Trauma Patients

Failure to Rescue in Geriatric Trauma: The Impact of Any Complication Increases with Age and Injury Severity in Elderly Trauma Patients

Provision of acute care pathways for older major trauma patients in the UK

Complications in low-risk older adult trauma patients: A case-control study

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