The Geriatric Trauma Institute: reducing the increasing burden of senior trauma care

DeLa’O, Connie; Kashuk, Jeffry L.; Rodríguez, Aurelio; Zipf, Jami; Dumire, Russell

doi:10.1016/j.amjsurg.2014.08.007

Cited by 27 publications

(12 citation statements)

References 20 publications

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“…Multiple strategies have been proposed for meeting this triage challenge. The ACS TQIP Geriatric Guideline11 currently recommends the following: 1) a lowered threshold for transporting injured patients to trauma centers,12–14 and 2) Level 1 or 2 conventional activations upon arrival,15 3) a lower threshold for laboratory7,16,17 and radiologic investigation 18,19…”

Section: Discussionmentioning

confidence: 99%

<p>Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria</p>

Fernandez¹,

Ong²,

Martin³

et al. 2019

OAEM

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BackgroundGeriatric patients are at increased risk of injury following low-energy mechanisms and are less tolerant of injury. Current criteria for trauma team activation (TTA) often miss these injuries. We evaluated a novel triage process for an expedited Emergency Medicine Physician evaluation protocol (T3) for at-risk geriatric sub-populations not meeting trauma team activation (TTA) criteria.MethodsRetrospective review of injured patients (≥65 years) from a Level II Trauma Center with an Injury Severity Score (ISS < 16), prior to (Pre-T3, Jan 2007-Oct 2009), and after (Post-T3, Jan 2010-Oct 2012), implementation of T3, as well as a contemporary period (CP, Jan 2013-Oct 2015). Demographics, physiologic variables, and timeliness of care were measured. Rates of ICU admission, operative procedures and lengths of stay and in-hospital mortality were compared for all periods. Logistic regression analysis determined variables independently associated with mortality.ResultsPost-T3, 49.2% of geriatric registry patients underwent T3 with a reduction in key time intervals. Median time to evaluation (42.1 mins vs 61.7 min, p<0.001), median time to CT (161.3 mins vs 212.9 mins, p<0.001) and EDLOS (364.6 mins vs 451.5 mins, p=0.023) were all reduced compared to non-expedited evaluations. There was no change in mortality after the implementation of the protocol.ConclusionThe T3 protocol expedited patient evaluation of at-risk geriatric patients that would not otherwise meet TTA criteria. The new process met the goals of the American College of Surgeons Trauma Quality Improvement Program while conserving resources.

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Section: Discussionmentioning

confidence: 99%

<p>Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria</p>

Fernandez¹,

Ong²,

Martin³

et al. 2019

OAEM

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“…There are no Class I data to support a standardized method for triaging geriatric trauma patients. 9 DeLa'O et al 10 discovered that admission to a dedicated Geriatric Trauma Service, which consisted of a multidisciplinary support team specific for geriatric trauma patients, resulted in decreased hospital length of stay and associated hospital charges when compared with admission to a non-Geriatric Trauma Service.…”

Section: Discussionmentioning

confidence: 99%

Pretrauma Functional Independence Measure Score Predicts Survival in Geriatric Trauma

Fletcher

Bradburn

Baker

et al. 2017

The American Surgeon

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The Functional Independence Measure (FIM) is used by rehabilitation professionals to access disability. The FIM score combines both motor and cognitive parameters to assess a patient's level of required assistance in performing activities of daily living (ADL). The geriatric trauma patient is becoming an increasingly important cohort for trauma services. FIM has been shown to predict discharge outcomes and those at high risk for falls. We hypothesized pretrauma FIM scores may predict survival in the geriatric trauma population. This was a retrospective study of patients 65 years and older that were admitted to our Level I trauma center from July 1, 2006 to July 1, 2012. A total 941 patients underwent stepwise regression to identify those factors predicting survival. Age, Injury Severity Score, revised trauma score, body mass index, and pretrauma FIM scores (12-point scale) were studied. The primary outcome was survival. Statistical significance reached at P value <0.05. Multiple logistic regression analysis was then performed. A total of 1315 patients were identified and complete data were available on 941 patients. Mean age was 78 (SD ± 8.2), mean Injury Severity Score was 13(SD ± 8.7), and mean body mass index was 26. Overall mortality was 11 per cent. The odds ratio of survival was 3.532 (95% confidence interval = 2.191–5.718) times greater for every 1-point increase in the preadmission FIM expression score. Glasgow Coma Scale, revised trauma score, gender, and pretrauma FIM expression scores were predictive of survival in the geriatric trauma patient. Pretrauma FIM expression can be used to predict survival in the elderly trauma victim. Further study is needed to establish the role of FIM as part of trauma scoring systems.

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“…[10][11][12][13][14][15] The mortality of a patient with geriatric trauma is nearly 5 times higher than the general population ranging from 15% to 30%. 2,16 According to the Geriatric Trauma Institute, in 2010, the estimated cost for care for patients with geriatric trauma was greater than US$30 billion. 2 With an increasing elderly population, significant cost, and a higher mortality rate, the discussions around end-of-life (EOL) care are essential not only to care for the patients on an individual level but also responsible for allocation of resources.…”

Section: Introductionmentioning

confidence: 99%

“…Between 2000 and 2010, this population increased at a faster rate (15.1%) than the total US population (9.7%) and is expected to comprise 20% of the total population by 2030. 1,2 Continued advancements in the management of chronic diseases have resulted in a more active lifestyle in elderly individuals, predisposing them to injury. 3 Trauma is the fifth leading cause of death in the geriatric population.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

End-of-Life Decision-Making for Patients With Geriatric Trauma Cared for in a Trauma Intensive Care Unit

Wooster

Stassi

Hill

et al. 2018

Am J Hosp Palliat Care

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The Geriatric Trauma Institute: reducing the increasing burden of senior trauma care

Cited by 27 publications

References 20 publications

<p>Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria</p>

<p>Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria</p>

Pretrauma Functional Independence Measure Score Predicts Survival in Geriatric Trauma

End-of-Life Decision-Making for Patients With Geriatric Trauma Cared for in a Trauma Intensive Care Unit

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