June 16, 2016

Does Automatic Trauma Surgery Activation Improve Outcomes in Elderly Trauma?

Kalina, M., Am Surg 82(6):496, June 2016

BACKGROUND: A trauma service activation and admission policy was instituted at a single center to improve triage and care for very elderly trauma patients (aged 90 years or older).

METHODS: This retrospective study from Staten Island University Hospital evaluated whether the trauma admission policy improved patient care and hospital efficiency. The study included elderly trauma patients (mean age 93 years; 76% female) admitted before policy implementation (244 control patients; 2011-2013) and after implementation (131 study patients; January-December 2014), excluding patients admitted to other surgical services. Efficiency outcomes were ICU and hospital lengths of stay; other endpoints included trauma service admission, complications, discharge disposition and mortality.

RESULTS: The most common injury was a fall with femur fracture. After policy implementation, admissions to the trauma service increased from 28.3% to 40.5% (p=0.02), while ICU stays decreased from 4.0 to 0.7 days (p<0.001) and hospital stays decreased from 7.3 to 6.3 days (p=0.005). Differences between groups were also recorded in rates of pneumonia (0.8% versus 5.3%; p=0.01), acute respiratory distress syndrome (0% versus 2.3%; p=0.04), and disposition to a skilled nursing facility (75.8% versus 57.3%; p<0.001). Mortality rates did not differ before versus after policy implementation (6.2% versus 10.1%; p=0.20). Admission to the trauma service was significantly associated with efficiency endpoints in multivariate analysis.

CONCLUSIONS: A trauma service activation and admission policy for very elderly patients safely was associated with some measures of hospital efficiency. 7 references (mkalina@nshs.edu for reprints)

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