The DEPARTS Score: A Novel Tool for Predicting Discharge Disposition in Geriatric Trauma Patients

Abstract

Background Geriatric trauma patients (GTPs) represent a high-risk population for needing post-acute care, such as skilled nursing facilities (SNFs) and long-term acute care hospitals (LTACs), due to a combination of traumatic injuries and baseline functional health. As there is currently no well-established tool for predicting these needs, we aimed to create a scoring tool that predicts disposition to SNFs/LTACs in GTPs. Methods The adult 2017 Trauma Quality Improvement Program database was divided at random into two equal sized sets (derivation and validation sets) of GTPs >65 years old. First, multiple logistic regression models were created to determine risk factors for discharge to a SNF/LTAC in admitted GTPs. Second, the weighted average and relative impact of each independent predictor was used to derive a DEPARTS ( Discharge of Elderly Patients After Recent Trauma to SNF/LTAC) score. We then validated the score using the area under the receiver-operating curve (AROC). Results Of 66 479 patients in the derivation set, 36 944 (55.6%) were discharged to a SNF/LTAC. Number of comorbidities, fall mechanism, spinal cord injury, long bone fracture, and major surgery were each independent predictors for discharge to SNF/LTAC, and a DEPARTS score was derived with scores ranging from 0 to 19. The AROC for this was .74. In the validation set, 66 477 patients also had a SNF/LTAC discharge rate of 55.7%, and the AROC was .74. Discussion The DEPARTS score is a good predictor of SNF/LTAC discharge for GTPs. Future prospective studies are warranted to validate its accuracy and clinical utility in preventing delays in discharge.

Factors Associated with Transfer from an Acute Geriatric Unit to a Post-Acute Care Facility among Community-Dwelling Patients: Results from the DAMAGE Cohort

“…In a study of surgical wards, Sacks et al 25 showed that older age, admission from another acute care facility, partial or full functional dependency before surgery, and a higher number of comorbidities were all associated with a greater risk-adjusted OR for transfer to PAC after various operations. The studies by Yeates 10 and Sattler 24 (in a trauma setting and after total knee arthroplasty, respectively) gave similar results. Chang 27 showed that the Activity Measure for Post-Acute Care “6-Clicks” Basic Mobility Inpatient Short Form score at admission to an acute stroke unit was the only significant predictor of transfer a post-acute inpatient rehabilitation facility.…”

“…4,5 Studies of surgical and neurology wards have shown that older age and poor functional independence are risk factors for transfer to PAC. [6][7][8][9] Specific tools [7][8][9][10] have been developed to identify patients at risk of transfer to PAC and it has been shown that the use of some of these tools is associated with a shorter length of hospital stay. 9,11 Acute geriatric units (AGUs) provide specific care for frail, dependent or multimorbid older adults with acute health problems.…”

Derivation and Validation of a Score Using Prehospital Data to Identify Adults With Trauma Requiring Early Laparotomy

“…This method to derive and validate a novel scoring tool has previously been performed in the literature. [8][9][10] All analyses were performed with IBM SPSS Statistics for Windows version 24 (IBM Corp). Data were collected and analyzed between July 2020 and September 2020.…”

“…PREPS was then validated in the validation cohort using the AUROC curve. This method to derive and validate a novel scoring tool has previously been performed in the literature . All analyses were performed with IBM SPSS Statistics for Windows version 24 (IBM Corp).…”

“…In addition, there were significant differences between these 2 groups for various prehospital variables, including vital signs in the field, mechanism of injury, and specific injury patterns. In the early laparotomy group, the in-hospital mortality was significantly higher (414 [20.2%] vs 6934 [3.7%], P < .001) and hospital length of stay was significantly longer (median [IQR], 7 [4][5][6][7][8][9][10][11][12][13] days vs 3 [2][3][4][5][6] days; P < .001).…”