Saillant N N, Earl-Royal E, Pascual J L, Allen S R, Kim P K, Delgado M K, Carr B G, Wiebe D, Holena D N
Department of Surgery, Harvard School of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Perelman School of Medicine at the University of Pennsylvania, 2400 Chestnut St., Apt 1907, Philadelphia, PA, 19103, USA.
Eur J Trauma Emerg Surg. 2017 Feb;43(1):121-127. doi: 10.1007/s00068-015-0586-9. Epub 2015 Oct 28.
Age is a risk factor for death, adverse outcomes, and health care use following trauma. The American College of Surgeons' Trauma Quality Improvement Program (TQIP) has published "best practices" of geriatric trauma care; adoption of these guidelines is unknown. We sought to determine which evidence-based geriatric protocols, including TQIP guidelines, were correlated with decreased mortality in Pennsylvania's trauma centers.
PA's level I and II trauma centers self-reported adoption of geriatric protocols. Survey data were merged with risk-adjusted mortality data for patients ≥65 from a statewide database, the Pennsylvania Trauma Systems Foundation (PTSF), to compare mortality outlier status and processes of care. Exposures of interest were center-specific processes of care; outcome of interest was PTSF mortality outlier status.
26 of 27 eligible trauma centers participated. There was wide variation in care processes. Four trauma centers were low outliers; three centers were high outliers for risk-adjusted mortality rates in adults ≥65. Results remained consistent when accounting for center volume. The only process associated with mortality outlier status was age-specific solid organ injury protocols (p = 0.04). There was no cumulative effect of multiple evidence-based processes on mortality rate (p = 0.50).
We did not see a link between adoption of geriatric best-practices trauma guidelines and reduced mortality at PA trauma centers. The increased susceptibility of elderly to adverse consequences of injury, combined with the rapid growth rate of this demographic, emphasizes the importance of identifying interventions tailored to this population.
III.
Descriptive.
年龄是创伤后死亡、不良结局及医疗保健使用的一个风险因素。美国外科医师学会创伤质量改进项目（TQIP）已发布老年创伤护理的“最佳实践”；这些指南的采用情况尚不清楚。我们试图确定哪些基于证据的老年协议，包括TQIP指南，与宾夕法尼亚州创伤中心死亡率的降低相关。
宾夕法尼亚州的一级和二级创伤中心自行报告老年协议的采用情况。调查数据与来自全州数据库宾夕法尼亚创伤系统基金会（PTSF）的65岁及以上患者的风险调整死亡率数据合并，以比较死亡率异常状态和护理过程。感兴趣的暴露因素是特定中心的护理过程；感兴趣的结局是PTSF死亡率异常状态。
27个符合条件的创伤中心中有26个参与。护理过程存在很大差异。四个创伤中心是低异常值；三个中心在65岁及以上成年人的风险调整死亡率方面是高异常值。在考虑中心容量时结果仍然一致。与死亡率异常状态相关的唯一过程是针对特定年龄的实体器官损伤协议（p = 0.04）。多个基于证据的过程对死亡率没有累积影响（p = 0.50）。
我们没有看到采用老年最佳实践创伤指南与宾夕法尼亚州创伤中心死亡率降低之间的联系。老年人对损伤不良后果的易感性增加，再加上这一人群的快速增长率，强调了确定针对该人群的干预措施的重要性。
III。
描述性。
