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. 2024 Sep;72(9):2752-2758.
doi: 10.1111/jgs.19054. Epub 2024 Jul 5.

The geriatric trauma hospitalist service: An analysis of a management strategy for injured older adults

Heather R Kregel  1   2   3 , Claudia Pedroza  4 , Fatimah Sunez  1 , Gina Khraish  1 , Ezenwa Onyema  1 , David E Meyer  1   2 , Sasha D Adams  1   3 , Lillian S Kao  1   2   3 , Laura J Moore  1   3 , Thaddeus J Puzio  1   2
Affiliations

The geriatric trauma hospitalist service: An analysis of a management strategy for injured older adults

Heather R Kregel et al. J Am Geriatr Soc. 2024 Sep.

Abstract

Background: Management of geriatric trauma patients requires balancing chronic comorbidities with acute injuries. We developed a care model in which patients are managed by hospitalists with trauma-centered education and hypothesized that clinical outcomes would be similar to outcomes in patients primarily managed by trauma surgeons.

Methods: This was a retrospective study of trauma patients aged ≥65 from January 2020 to December 2021. Groups were defined by admitting service: trauma surgery service (TSS) or geriatric trauma hospitalist service (GTHS). The primary outcome was in-hospital mortality. Regression analyses and inverse probability treatment weighted (IPTW) propensity score (PS) analyses were performed to determine the association between admitting service and outcomes.

Results: A total of 1004 patients were eligible for inclusion-580 GTHS and 424 TSS admissions. GTHS patients were older (82 vs. 74, p < 0.001), more likely to have suffered blunt trauma (99.5% vs. 95%, p < 0.001), more likely to have comorbidities (91.2% vs. 87%, p < 0.001), had higher Charlson Comorbidity Indexes (CCIs), and had lower median injury severity scores (9 vs. 13, p < 0.001). Rates of mortality, delirium, 30-day readmission, and overall complications were low and similar between groups. While TSS patients were likely to be discharged home, GTHS had more discharges to skilled nursing facilities and longer length of stay (LOS). On multivariable analysis adjusted for age, ISS, CCI, and sex, patients admitted to GTHS had lower odds of death with an odds ratio of 0.15 (95% confidence interval [CI] 0.02-0.75, p = 0.03) when compared to TSS. On IPTW PS analysis, patients admitted to GTHS had similar odds of death with an odds ratio of 0.3 (95% CI 0.06-1.6, p = 0.16).

Conclusions: Protocolized admission criteria to a GTHS resulted in similar low mortality rates but longer LOS when compared to patients admitted to a TSS. This care model may inform other trauma centers in developing their strategies for managing the increasing volume of vulnerable injured older adults.

Keywords: geriatric admission; geriatric trauma; trauma hospitalist.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
Admission protocol flowsheet (suggested for color)
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). cdc.gov/injury/wisqars
    1. Perdue P, Watts D, Kaufmann C, Trask A. Differences in Mortality between Elderly and Younger Adult Trauma Patients: Geriatric Status Increases Risk of Delayed Death. J Trauma Inj Infect Crit Care. 1998;45(4):805–810. - PubMed
    1. Best Practice Guidelines: Geriatric Trauma Management. American College of Surgeons. Published 2023. https://www.facs.org/media/ubyj2ubl/best-practices-guidelines-geriatric-...
    1. Olufajo OA, Tulebaev S, Javedan H, et al. Integrating geriatric consults into routine care of older trauma patients: One-year experience of a level i trauma center. J Am Coll Surg 2016;222(6):1029–1035. doi: 10.1016/j.jamcollsurg.2015.12.058 - DOI - PubMed
    1. Bradburn E, Rogers FB, Krasne M, et al. High-risk geriatric protocol: Improving mortality in the elderly. J Trauma Acute Care Surg 2012;73(2):435–440. doi: 10.1097/TA.0b013e31825c7cf4 - DOI - PubMed