Study Quality and Patient Inclusion in Geriatric Orthopaedic Trauma Research: A Scoping Review

Abstract

Objectives: To evaluate the quality of evidence published in geriatric traumatology, to investigate how many studies include patients with cognitive impairment, and to investigate which methods are used to determine cognitive impairment. Data Sources: A search was conducted in PubMed for all publications in English in 154 selected journals between 01/01/2017 and 01/01/2020. Study Selection: Clinical studies investigating patients 65 years of age and older with fractures in the appendicular skeleton or pelvis were included. Data Extraction: Two independent reviewers performed full-text screening and data extraction for all articles. Data Synthesis: A comparative analysis was performed for prospective cohort studies and RCTs. The results are discussed in a narrative review. Conclusions: A total of 2711 publications were screened for eligibility, and after exclusion, a total of 723 articles were included. There is a focus on retrospective studies investigating mortality and complications. Studies are often small in sample size, and there are relatively few prospective studies, RCT studies, patient-reported outcomes, and quality of life. Patients with cognitive impairment are selectively excluded from clinical studies, and no consensus exists on how cognitive impairment is diagnosed. This review identified pitfalls and provides recommendations to navigate these issues for future studies. Many studies exclude cognitively impaired patients, which may result in selection bias and inability to extrapolate results. The lack of use of objective measures to define cognitive impairment and lack appropriate outcome measures for the cognitively impaired is an important issue that needs to be addressed in future research.