Improving geriatric trauma outcomes: A small step toward a big problem

Peter M. Hammer, Annika C. Storey, Teresa Bell, Demetria Bayt, Melissa S. Hockaday, Ben L. Zarzaur, David V. Feliciano, Grace Rozycki

Research output: Contribution to journalArticle

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). X2 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.

Original languageEnglish (US)
Pages (from-to)162-166
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Geriatrics
Injury Severity Score
Wounds and Injuries
Hospital Emergency Service
Hypotension
Comorbidity
Length of Stay
Mortality
Nonparametric Statistics
Odds Ratio
Confidence Intervals
Triage
Trauma Centers
Demography
Outcome Assessment (Health Care)

Keywords

  • Geriatric trauma
  • Postinjury outcomes
  • Triage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Improving geriatric trauma outcomes : A small step toward a big problem. / Hammer, Peter M.; Storey, Annika C.; Bell, Teresa; Bayt, Demetria; Hockaday, Melissa S.; Zarzaur, Ben L.; Feliciano, David V.; Rozycki, Grace.

In: Journal of Trauma and Acute Care Surgery, Vol. 81, No. 1, 01.01.2016, p. 162-166.

Research output: Contribution to journalArticle

Hammer, PM, Storey, AC, Bell, T, Bayt, D, Hockaday, MS, Zarzaur, BL, Feliciano, DV & Rozycki, G 2016, 'Improving geriatric trauma outcomes: A small step toward a big problem', Journal of Trauma and Acute Care Surgery, vol. 81, no. 1, pp. 162-166. https://doi.org/10.1097/TA.0000000000001063
Hammer, Peter M. ; Storey, Annika C. ; Bell, Teresa ; Bayt, Demetria ; Hockaday, Melissa S. ; Zarzaur, Ben L. ; Feliciano, David V. ; Rozycki, Grace. / Improving geriatric trauma outcomes : A small step toward a big problem. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 81, No. 1. pp. 162-166.
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