Impact of a geriatric consultation service on outcomes in older trauma patients: a before–after study

Lampron, Jacinthe; Khoury, Lara; Moors, Joy; Nemnom, Marie‐Joe; Figueira, Sonshire; Podinic, Irina; Eagles, Debra

doi:10.1007/s00068-021-01724-x

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…[31][32][33] There may be some potential benefits in selected outcomes, such as advance care planning and multidisciplinary care, but overall, the studies have identified the need for additional review of clinical and cost effectiveness of geriatricians in the trauma setting. [34][35][36][37][38][39][40] Fellowship-trained geriatric surgeons may be optimal for a trauma service with a growing cohort of GTPs, but obstacles to this focused training, including financial impact to the surgeon returning to fellowship training and time required to train, limit growth in this specialty. 41 We used a nursing team to provide oversight of the time required for end-of-life discussions and palliative education in the frailest patients (FRAIL score, 5).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have looked at the effectiveness of geriatric consults for GTPs and have identified mixed results 31–33 . There may be some potential benefits in selected outcomes, such as advance care planning and multidisciplinary care, but overall, the studies have identified the need for additional review of clinical and cost effectiveness of geriatricians in the trauma setting 34–40 . Fellowship-trained geriatric surgeons may be optimal for a trauma service with a growing cohort of GTPs, but obstacles to this focused training, including financial impact to the surgeon returning to fellowship training and time required to train, limit growth in this specialty 41 .…”

Section: Discussionmentioning

confidence: 99%

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GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

Wintz,

Schaffer,

Hites

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Considering resources for comprehensive geriatric care, it would be beneficial for geriatric trauma patients (GTPs) and medical patients to be comanaged in one program focusing on ancillary therapeutics (AT): physical therapy, occupational therapy, speech language pathology, respiratory therapy, and sleep wake hygiene. This pilot study describes outcomes of GTPs in a hospital-wide program focused on geriatric-specific AT. METHODS Geriatric trauma patients and geriatric patients were screened by program coordinator for enrollment at one Level II trauma center from August 2021 to December 2022. Enrolled patients (EPs) were admitted to trauma or medicine floors and received repetitive AT with attention to sleep wake hygiene throughout hospitalization and compared with similar nonenrolled patients (NEPs). Excluded patients had any of the following: indication of geriatric syndrome with a fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) score of 5, no frailty with a FRAIL score of 0, comfort focused plans, or arrived from skilled care. Retrospective chart review of demographics and outcomes was completed for both EPs and NEPs. RESULTS A total of 224 EPs (28 trauma [TR]) were compared with 574 NEPs (148 TR). Enrolled patients showed shorter length of stay (mean, 3.8 vs. 6.1; p = 0.0001), less delirium (3.1% vs. 9.6%, p = 0.00222), less time to ambulation (13 hours vs. 39 hours, p = 0.0005), and higher likelihood to discharge home (56% vs. 27%, p < 0.0001) as compared with NEPs. The median FRAIL score was 3 for both groups. Enrolled medical patients ambulated the soonest at 11 average hours, compared with 23 hours for enrolled trauma patients and 39 hours for NEPs. There were zero delirium events among enrolled trauma patients; 25% was found among nonenrolled trauma patients (p = 0.00288). CONCLUSION Despite a small trauma cohort, results support feasibility to include GTPs in hospital-wide programs with geriatric-specific AT. Mobility and cognitive strategies may improve opportunities to avoid delirium, decrease length of stay, and influence more frequent disposition to home. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

Wintz,

Schaffer,

Hites

et al. 2023

J Trauma Acute Care Surg

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“…Attention has focused on the need to provide geriatrician input into the care of older major trauma patients [13,44], although the optimum model is not known. Several examples of major trauma geriatrician models have been proposed with positive effects on length of stay, in-hospital complications and discharge destination [17,22,52]. Recently a payment subsidy has been introduced within the UK, requiring patients aged 65 and over to have a frailty assessment completed within 72 hours of admission to an MTC by a geriatrician [35].…”

Section: Discussionmentioning

confidence: 99%

“…The need for focused and specialist care for older trauma patients has been suggested as a way to address these deficits with the development of a number of clinical standards, guidelines and recommendations [13][14][15]. In addition, 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 [16,17].…”

Section: Introductionmentioning

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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“…Many guidelines suggest geriatric assessment within 72 hours; geriatric input has a well-established reduction in mortality, complications, delirium and length of stay in critical care 23 32. Such individualistic approaches improve care and ultimately reduce mortality 24 33 34. A large multicentre study32 did identify an increased length of stay following geriatric assessment, but there is evidence to suggest that geriatric review compliance is variable in the UK 30.…”

Section: Global Health Problem Analysismentioning

confidence: 99%

Trauma in the elderly: a bilateral rectus sheath haematoma

McArdle

2023

BMJ Case Rep

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Life expectancy has more than doubled in the last century, and a new cohort of elderly and increasingly frail patients is presenting to emergency departments with new clinical challenges. When this patient cohort presents after injury, all aspects of clinical practice have to be recalibrated to provide safe and appropriate care. The prevalence of chronic disease, levels of organ failure, multiple comorbidities, greater use of anticoagulation and incidence of recurrent low- and high-impact trauma may delay and obscure diagnosis and, ultimately, increase mortality.Older age is a risk factor for rectus sheath haematoma (RSH), which is haemorrhage into the potential space surrounding the rectus abdominis muscle/s. It is a rare presentation following trauma but can provide diagnostic challenges and be fatal. Even more rare is bilateral RSH with only 12 reported in the literature since 1981.This case report describes bilateral RSH presenting in an elderly woman following a fall and the consequences of seemingly minor trauma in the elderly.

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Impact of a geriatric consultation service on outcomes in older trauma patients: a before–after study

Cited by 6 publications

References 13 publications

GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

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

Trauma in the elderly: a bilateral rectus sheath haematoma

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