Geriatric trauma service

Mangram, Alicia; Mitchell, Christopher; Shifflette, Vanessa; Lorenzo, Manuel; Truitt, Michael S.; Goel, Anuj Kumar; Lyons, Mark; Nichols, Deborah; Dunn, Erica H.

doi:10.1097/ta.0b013e318241f0ba

Cited by 100 publications

(43 citation statements)

References 10 publications

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“…As falls are now the leading cause of death in our large urban trauma center, this further emphasizes the need for aggressive prevention efforts in this group and specialized care of this vulnerable population. (43) …”

Section: Discussionmentioning

confidence: 99%

Trends in 1029 trauma deaths at a level 1 trauma center: Impact of a bleeding control bundle of care

Oyeniyi

Fox

Scerbo

et al. 2017

Injury

220

141

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Background Over the last decade the age of trauma patients and injury mortality has increased. At the same time, many centers have implemented multiple interventions focused on improved hemorrhage control, effectively resulting in a bleeding control bundle of care. The objective of our study was to analyze the temporal distribution of trauma-related deaths, the factors that characterize that distribution and how those factors have changed over time at our urban level 1 trauma center. Methods Records at a urban Level 1 trauma center were reviewed. Two time periods (2005–2006 and 2012–2013) were included in the analysis. Mortality rates were directly adjusted for age, gender and mechanism of injury. The Mann-Whitney and chi square tests were used to compare variables between periods, with significance set at 0.05. Results 7080 patients (498 deaths) were examined in 2005–2006, while 8767 patients (531 deaths) were reviewed in 2012–2013. The median age increased 6 years, with a similar increase in those who died. In patients that died, no differences by gender, race or ethnicity were observed. Fall-related deaths are now the leading cause of death. Traumatic brain injury (TBI) and hemorrhage accounted for > 91% of all deaths. TBI (61%) and multiple organ failure or sepsis (6.2%) deaths were unchanged, while deaths associated with hemorrhage decreased from 36% to 25% (p<0.01). Across time periods, 26% of all deaths occurred within one hour of hospital arrival, while 59% occurred within 24 hours. Unadjusted mortality dropped from 7.0% to 6.1% (p=0.01) and in-hospital mortality dropped from 6.0% to 5.0% (p<0.01). Adjusted mortality dropped 24% from 7.6% (95% CI: 6.9–8.2) to 5.8% (95% CI: 5.3–6.3) and in-hospital mortality decreased 30% from 6.6% (95% CI: 6.0–7.2) to 4.7 (95% CI: 4.2–5.1). Conclusions Over the same time frame of this study, increases in trauma death across the globe have been reported. This single-site study demonstrated a significant reduction in mortality, likely attributable to decreased hemorrhagic death. It is possible that efforts focused on hemorrhage control interventions (a bleeding control bundle) resulted in this reduction. These changing factors provide guidance on future prevention and intervention efforts.

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Section: Discussionmentioning

confidence: 99%

Trends in 1029 trauma deaths at a level 1 trauma center: Impact of a bleeding control bundle of care

Oyeniyi

Fox

Scerbo

et al. 2017

Injury

220

141

View full text Add to dashboard Cite

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“…Emergency surgical services have improved from structural changes and clear management pathways over the past recent years [ 5 , 6 ]. The trauma community, hit by the wave of elderly injured patients already, has started to organize focused multidisciplinary services that focus on the pathway of care that incorporates the geriatric considerations [ 7 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Geriatric emergency surgery behoves the recognition of multidisciplinary approach, including geriatric specialists in the overall work-up and treatment planning together with the surgeon. Geriatric consultation has been demonstrated for hip fracture care and trauma patients with improvements in outcome [ 9 , 14 ]. The problem remains in access to and the number of geriatric specialists, which is a limited resource in most hospitals.…”

Section: Introductionmentioning

confidence: 99%

Emergency surgery in the elderly: the balance between function, frailty, fatality and futility

Søreide

Desserud

2015

Scand J Trauma Resusc Emerg Med

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Becoming old is considered a privilege and results from the socioeconomic progress and improvements in health care systems worldwide. However, morbidity and mortality increases with age, and even more so in acute onset disease. With the current prospects of longevity, a considerable number of elderly patients will continue to live with good function and excellent quality of life after emergency surgical care. However, mortality in emergency surgery may be reported at 15-30%, doubled if associated with complications, and notably higher in patients over 75 years. A number of risks associated with death are reported, and a number of scores proposed for prediction of risk. Frailty, a decline in the physiological reserves that may make the person vulnerable to even the most minor of stressful event, appears to be a valid indicator and predictor of risk and poor outcome, but how to best address and measure frailty in the emergency setting is not clear. Futility may sometimes be clearly defined, but most often becomes a borderline decision between ethics, clinical predictions and patient communication for which no solid evidence currently exists. The number and severity of other underlying condition(s), as well as the treatment alternatives and their consequences, is a complex picture to interpret. Add in the onset of the acute surgical disease as a further potential detrimental factor on function and quality of life – and you have a perfect storm to handle. In this brief review, some of the challenging aspects related to emergency surgery in the elderly will be discussed. More research, including registries and trials, are needed for improved knowledge to a growing health care challenge.

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“…[2][3][4][5][6] This trauma program is a state accredited level 1 regional resource trauma center. A coordinated, multidisciplinary approach to the care of the elderly trauma patient may decrease the length of stay (LOS), morbidity, and mortality as evidenced by recent studies.…”

Section: Evaluation Of a Virtual Geriatric Trauma Institutementioning

confidence: 99%

Evaluation of a Virtual Geriatric Trauma Institute

Katrancha

Zipf

2014

Journal of Trauma Nursing

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Geriatric trauma patients require specialized care. Objective of this study was to compare outcomes for geriatric trauma patients before and after the implementation of a virtual geriatric trauma institute. This is a retrospective chart review of 583 trauma patients older than 65 years admitted to a rural level 1 trauma center before and after the implementation of a geriatric trauma institute. Length of stay was decreased from 4.99 to 3.9 days (P = .0014). Emergency department length of stay was decreased by approximately 10 minutes (P = .059), and time from the emergency department to the operating room was decreased by 470 minutes (P = .262).

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Geriatric trauma service

Abstract: Our data from the 1-year experience of our G-60 unit show that addressing the specific needs of elderly trauma patients will lead to better outcomes.

Cited by 100 publications

References 10 publications

Trends in 1029 trauma deaths at a level 1 trauma center: Impact of a bleeding control bundle of care

Trends in 1029 trauma deaths at a level 1 trauma center: Impact of a bleeding control bundle of care

Emergency surgery in the elderly: the balance between function, frailty, fatality and futility

Evaluation of a Virtual Geriatric Trauma Institute

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