The Association of Time to Palliative Medicine Consultation on Geriatric Trauma Outcomes
| Autor: | Barbara M. Hileman, Diane T. Kupensky, Eric S. Emerick, Elisha A. Chance |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Population Emergency Nursing Critical Care Nursing Logistic regression Patient Readmission Time-to-Treatment Cohort Studies Geriatric trauma Percutaneous endoscopic gastrostomy medicine Humans education Geriatric Assessment Referral and Consultation Aged Ohio Retrospective Studies Advanced and Specialized Nursing Aged 80 and over education.field_of_study Trauma Nursing business.industry Trauma center Palliative Care Retrospective cohort study medicine.disease Treatment Outcome Emergency medicine Practice Guidelines as Topic Injury Severity Score Female business Cohort study |
| Zdroj: | Journal of trauma nursing : the official journal of the Society of Trauma Nurses. 27(3) |
| ISSN: | 1078-7496 |
| Popis: | The integration of specialized geriatric providers with trauma services has received increased attention with promising results. Palliative medicine consultation (PMC) has been shown to reduce length of stay, improve symptom management, and clarify advance directives in the geriatric trauma population. The aim of this study was to evaluate whether PMC reduced tracheostomies and percutaneous endoscopic gastrostomies (trach/PEG) and readmission rates in the geriatric trauma population. Retrospective cohort analysis of patients 65 years of age and older, admitted to a Level I trauma center surgical intensive care unit from 2013 to 2014. Patients who died within 1 day were excluded. Statistical analyses included descriptive statistics, independent-samples t test for continuous variables, χ test for categorical variables, and logistic regression analysis. A total of 202 patients were included. Palliative medicine consultation occurred in 48%. Average time from admission to PMC was 2.91 days. Thirty-day readmission rate was 19.3%. Patients with a PMC (69.1%) were less likely to undergo trach/PEG (30.9%; p.001) but more likely if the consult was late (72 hr posttrauma; 22.0% vs. 40.4%; p = .05). Patients without a trach/PEG were more likely to survive 1 year posttrauma (85.7% vs. 14.3%; p = .003). Thirty-day readmission rates were similar between groups. In a logistic regression analysis, PMC, age, and injury severity score demonstrated an independent association with trach/PEG (all p.05). Early palliative consults (72 hr posttrauma) for geriatric trauma patients may reduce tracheostomy and percutaneous endoscopic gastrostomy procedures and hospital stays. |
| Databáze: | OpenAIRE |
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