Frailty Identification and Care Pathway: An Interdisciplinary Approach to Care for Older Trauma Patients
| Autor: | Steven S. Senglaub, Lynne O'Mara, Zara Cooper, Elizabeth Bryant, Meghan McDonald, Manuel Castillo-Angeles, Ali Salim, Esther Moberg, Samir Tulebaev |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Frail Elderly Population 030230 surgery Patient Readmission 03 medical and health sciences 0302 clinical medicine Injury Severity Score Geriatric trauma Internal medicine medicine Humans Hospital Mortality education Geriatric Assessment Aged Retrospective Studies Geriatrics Aged 80 and over education.field_of_study Frailty business.industry Trauma center Delirium Retrospective cohort study Odds ratio medicine.disease 030220 oncology & carcinogenesis Critical Pathways Wounds and Injuries Surgery Female medicine.symptom business |
| Zdroj: | Journal of the American College of Surgeons. 228(6) |
| ISSN: | 1879-1190 |
| Popis: | Background Frailty is a well-established marker of poor outcomes in geriatric trauma patients. There are few interventions to improve outcomes in this growing population. Our goal was to determine if an interdisciplinary care pathway for frail trauma patients improved in-hospital mortality, complications, and 30-day readmissions. Study Design This was a retrospective cohort study of frail patients ≥65 years old, admitted to the trauma service at an academic, urban level I trauma center between 2015 and 2017. Patients transferred to other services and those who died within the first 24 hours were excluded. An interdisciplinary protocol for frail trauma patients, including early ambulation, bowel/pain regimens, nonpharmacologic delirium prevention, nutrition/physical therapy consults, and geriatrics assessments, was implemented in 2016. Our main outcomes were delirium, complications, in-hospital mortality, and 30-day readmission, which were compared with these outcomes in patients treated the year before the pathway was implemented. Multivariate logistic regression was used to determine the association of being on the pathway with outcomes. Results There were 125 and 144 frail patients in the pre- and post-intervention cohorts, respectively. There were no significant demographic differences between the 2 groups. Among both groups, the mean age was 83.51 years (SD 7.11 years), 60.59% were female, and median Injury Severity Score was 10 (interquartile range 9 to 14). In univariate analysis, there were no significant differences in complications (28.0% vs 28.5%, respectively, p = 0.93); however, there was a significant decrease in delirium (21.6% to 12.5%, respectively, p = 0.04) and 30-day readmission (9.6% to 2.7%, respectively, p = 0.01). After adjusting for patient characteristics, patients on the pathway had lower delirium (odds ratio [OR] 0.44, 95% CI 0.22 to 0.88, p = 0.02) and 30-day readmission rates (OR 0.25, 95% CI 0.07 to 0.84, p = 0.02), than pre-pathway patients. Conclusions An interdisciplinary care protocol for frail geriatric trauma patients significantly decreases their delirium and 30-day readmission risk. Implementing pathways standardizing care for these vulnerable patients could improve their outcomes after trauma. |
| Databáze: | OpenAIRE |
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