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

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-07-05 DOI:10.1111/jgs.19054

Heather R. Kregel MD, MS, Claudia Pedroza PhD, Fatimah Sunez BS, Gina Khraish MD, Ezenwa Onyema MD, David E. Meyer MD, Sasha D. Adams MD, Lillian S. Kao MD, MS, Laura J. Moore MD, Thaddeus J. Puzio MD

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引用次数: 0

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.

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老年创伤住院医师服务：分析受伤老年人的管理策略。

背景：老年创伤患者的管理需要兼顾慢性合并症和急性损伤。我们开发了一种护理模式，由接受过以创伤为中心的教育的住院医师管理患者，并假设临床结果将与主要由创伤外科医生管理的患者结果相似：这是一项回顾性研究，研究对象是 2020 年 1 月至 2021 年 12 月年龄≥65 岁的创伤患者。根据入院服务确定分组：创伤外科服务（TSS）或老年创伤住院医师服务（GTHS）。主要结果是院内死亡率。通过回归分析和反概率治疗加权（IPTW）倾向评分（PS）分析来确定入院服务与结果之间的关联：共有 1004 名患者符合纳入条件，其中 580 名为 GTHS 患者，424 名为 TSS 患者。GTHS患者的年龄更大（82岁对74岁，P 结论：GTHS患者的年龄更大：与 TSS 相比，GTHS 的规范化入院标准导致了相似的低死亡率，但较长的 LOS。这种护理模式可为其他创伤中心提供借鉴，帮助他们制定策略，管理日益增多的易受伤老年人。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.