Journal article
Improving geriatric trauma outcomes: A small step toward a big problem
The journal of trauma and acute care surgery, Vol.81(1), pp.162-167
07/01/2016
DOI: 10.1097/TA.0000000000001063
PMID: 27032005
Abstract
BACKGROUND: Because of the unique physiology and comorbidities of injured geriatric patients, specific interventions are needed to improve outcomes. The purpose of this study was to assess the effect of a change in triage criteria for injured geriatric patients evaluated at an American College of Surgeons Level I trauma center.
METHODS: As of October 1, 2013, all injured patients 70 years or older were mandated to have the highest-level trauma activation upon emergency department (ED) arrival regardless of physiology or mechanism of injury. Patients admitted before that date were designated as PRE; those admitted after were designated as POST. The study period was from October 1, 2011, through April 30, 2015. Data collected included demographics, mechanism of injury, hypotension on admission, comorbidities, Injury Severity Score (ISS), ED length of stay (LOS), complications, and mortality. Bivariate and multivariable analyses were used to compare outcomes between the study groups (p < 0.05 was considered significant). chi(2) or Fisher's exact test was used as appropriate for bivariate analyses of categorical variables; patients' ages were compared using the Wilcoxon rank-sum test.
RESULTS: A total of 2,269 patients (mean, 80.63 years; mean ISS, 12.2; PRE, 1,271; POST, 933) were included in the study. On multivariable analysis, increasing age, higher ISS, and hypotension were associated with higher mortality. POST patients were more likely to have an ED LOS of 2 hours or shorter (odds ratio, 1.614; 95% confidence interval, 1.088-2.394) after controlling for hypotension, ISS, and comorbidities. POST mortality significantly decreased (odds ratio, 0.689; 95% confidence interval, 0.484-0.979).
CONCLUSION: Based on age alone, the focused intervention of a higher level of trauma activation decreased ED LOS and mortality in injured geriatric patients. (J Trauma Acute Care Surg. 2016; 81: 162-167. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.)
Details
- Title: Subtitle
- Improving geriatric trauma outcomes: A small step toward a big problem
- Creators
- Peter M. Hammer - Indiana University – Purdue University IndianapolisAnnika C. Storey - Indiana University – Purdue University IndianapolisTeresa Bell - Indiana University – Purdue University IndianapolisDemetria Bayt - Indiana University – Purdue University IndianapolisMelissa S. Hockaday - Indiana University – Purdue University IndianapolisBen L. Zarzaur - Indiana University – Purdue University IndianapolisDavid V. Feliciano - Indiana University – Purdue University IndianapolisGrace S. Rozycki - Indiana University – Purdue University Indianapolis
- Resource Type
- Journal article
- Publication Details
- The journal of trauma and acute care surgery, Vol.81(1), pp.162-167
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/TA.0000000000001063
- PMID
- 27032005
- ISSN
- 2163-0755
- eISSN
- 2163-0763
- Number of pages
- 6
- Language
- English
- Date published
- 07/01/2016
- Academic Unit
- Surgery
- Record Identifier
- 9984701549002771
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