Department of Medicine, University of Saskatchewan, Saskatchewan, Canada.
Ann Surg. 2012 Dec;256(6):1098-101. doi: 10.1097/SLA.0b013e318270f27a.
To describe and evaluate an inpatient geriatric trauma consultation service (GTCS).
Delays in recognizing the special needs of older trauma patients may result in suboptimal care. The GTCS is a proactive geriatric consultation model aimed at preventing and managing age-specific complications and discharge planning for all patients 60 years or older admitted to the St Michael's Hospital Trauma Service.
This was a before and after case series of patients admitted pre-GTCS (March 2005-August 2007) and post-GTCS (September 2007-March 2010). Study data were derived from a review of the medical records and from the St Michael's Hospital trauma registry. Abstracted data included demographics, type of geriatric issues addressed, rate of adherence to recommendations made by the GTCS, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests, and discharge destinations.
A total of 238 pre-GTCS patients and 248 post-GTCS patients were identified. The rate of adherence to recommendations made by the GTCS team was 93.2%. There were fewer consultation requests made to Internal Medicine and Psychiatry in the post-GTCS group (N = 31 vs N = 18, P = 0.04; and N = 33 vs N = 18, P = 0.02; respectively). There were no differences in any of the prespecified complications except delirium (50.5% pre-GTCS vs 40.9% post- GTCS, P = 0.05). Among patients admitted from home, fewer were discharged to long-term care facilities among the post-GTCS group (6.5% pre-GTCS vs 1.7% post-GTCS, P = 0.03).
A proactive geriatric consultation model for elderly trauma patients may decrease delirium and discharges to long-term care facilities. Future studies should include a multicenter randomized trial of this model of care.
描述并评估一种住院老年创伤咨询服务（GTCS）。
延迟识别老年创伤患者的特殊需求可能导致护理效果不佳。GTCS 是一种主动的老年咨询模式，旨在预防和管理所有年龄在 60 岁及以上入住圣迈克尔医院创伤服务的患者的特定年龄并发症，并进行出院计划。
这是一项 GTCS 前（2005 年 3 月至 2007 年 8 月）和 GTCS 后（2007 年 9 月至 2010 年 3 月）的病例系列研究。研究数据来自对病历和圣迈克尔医院创伤登记处的审查。提取的数据包括人口统计学特征、解决的老年问题类型、GTCS 建议的遵循率、老年特定临床结局、创伤质量指标、咨询请求和出院目的地。
共确定了 238 例 GTCS 前患者和 248 例 GTCS 后患者。GTCS 团队的建议遵循率为 93.2%。GTCS 后组中向内科和精神病科提出的咨询请求较少（N = 31 比 N = 18，P = 0.04；N = 33 比 N = 18，P = 0.02）。除谵妄外（GTCS 前组 50.5%，GTCS 后组 40.9%，P = 0.05），任何预定并发症均无差异。在家中入院的患者中，GTCS 后组出院到长期护理机构的人数较少（GTCS 前组 6.5%，GTCS 后组 1.7%，P = 0.03）。
针对老年创伤患者的主动老年咨询模式可能会减少谵妄和长期护理机构的出院人数。未来的研究应包括对这种护理模式的多中心随机试验。
