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

Autor: Lampron J; Department of Surgery, University of Ottawa, Ottawa, ON, Canada.; Ottawa Hospital Research Institute, Ottawa, ON, Canada., Khoury L; Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Department of Medicine, University of Ottawa, Ottawa, ON, Canada., Moors J; Department of Geriatrics, The Ottawa Hospital, Ottawa, ON, Canada., Nemnom MJ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada., Figueira S; Ottawa Regional Trauma Program, The Ottawa Hospital, Ottawa, ON, Canada., Podinic I; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Eagles D; Ottawa Hospital Research Institute, Ottawa, ON, Canada. deagles@toh.ca.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. deagles@toh.ca.; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. deagles@toh.ca.; The Ottawa Hospital, Civic Campus, 1053 Carling Ave, Ottawa, ON, F658aK1Y 4E9, Canada. deagles@toh.ca.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2022 Aug; Vol. 48 (4), pp. 2859-2865. Date of Electronic Publication: 2021 Jun 19.
DOI: 10.1007/s00068-021-01724-x
Abstrakt: Purpose: Early geriatric involvement is recommended for older trauma patients. We wished to determine the impact of geriatric consultation on mortality, hospital length of stay and discharge disposition in older patients who were admitted to our Level 1 trauma unit.
Methods: We completed a health records review of trauma unit patients, age ≥ 75 years old with Injury Severity Score (ISS) ≥ 12, before (11/2015-10/2017) and after (11/2017-10/2019) implementation of a geriatric trauma consultation initiative. Primary outcomes were mortality, hospital length of stay and discharge destination. Secondary objectives were adherence to the geriatric trauma consult process and identification of geriatric-specific issues. A multivariable analysis controlling for age, gender, multi-morbidity and ISS was undertaken.
Results: 157 patients pre-implementation and 172 post-implementation with mean age 83.8 years and 53.8% females were included. Geriatric consultation had no impact on in-hospital mortality [OR 0.70 (95% CI 0.31-1.58)] or length of stay [ß 0.68 (95%CI - 1.35-2.72)]. Patients who received a geriatric consultation were more likely to be discharged home (OR 2.01 (95% CI 1.24-3.24). The adherence to consultation process was 99.4%. Mobility, pain and cognitive impairment were the most common geriatric concerns, identified in 76.6, 61.1 and 50.0% of older trauma patients, respectively.
Conclusion: Older trauma patients that receive geriatric trauma consultation are more likely to be discharged home. Collaboration between trauma and geriatric specialists is beneficial and may lead to meaningful improvements in outcomes for older trauma patients.
(© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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