Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA.
Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
J Am Coll Surg. 2016 Jun;222(6):1029-35. doi: 10.1016/j.jamcollsurg.2015.12.058. Epub 2016 Mar 3.
Although involvement of geriatricians in the care of older trauma patients is associated with changes in processes of care and improved outcomes, few geriatrician consultations were ordered on our service.
Mandatory geriatric consults were initiated in September 2013 for all trauma patients 70 years and older admitted to our hospital. We prospectively collected data on patients admitted from October 2013 through September 2014 (postintervention) and compared their data with those of patients admitted from June 2011 through June 2012 (preintervention). We collected data on processes of care (DNR and do not intubate status, delirium, and referral for cognitive evaluation) and patient outcomes (mortality, readmission, and length of stay). Descriptive statistics and post-hoc power analyses were performed.
There were 215 and 191 patients included in the preintervention and postintervention cohorts, respectively. After the intervention, geriatric consults increased from 3.26% to 100%. Patients with DNR and do not intubate status increased from 10.23% to 38.22% (p < 0.01). Referral for formal cognitive evaluation increased from 2.33% to 14.21% (p < 0.01) and delirium documentation increased from 31.16% to 38.22% (p = 0.14). In-hospital mortality and 30-day mortality in the pre- and postintervention periods were 9.30% vs 5.24% (p = 0.12) and 11.63% vs 6.81% (p = 0.10), respectively. Intensive care unit readmission rate was 8.26% preintervention and 1.96% postintervention (p = 0.06). There were no changes in 30-day hospital readmission and length of stay. Power analyses showed more patients were needed to show statistically significant outcomes.
The initiation of mandatory geriatric consults on our trauma service was associated with improved advance care planning and increased multidisciplinary care. Ensuring involvement of geriatricians can aid in reducing adverse outcomes among geriatric trauma patients.
尽管老年病医生参与老年创伤患者的治疗与治疗过程的改变和结果的改善有关，但我们的服务中很少有老年病医生的会诊。
2013 年 9 月，我们对所有 70 岁及以上入住我院的创伤患者启动了强制性老年病会诊。我们前瞻性地收集了 2013 年 10 月至 2014 年 9 月（干预后）入院患者的数据，并将其与 2011 年 6 月至 2012 年 6 月（干预前）入院患者的数据进行了比较。我们收集了治疗过程（DNR 和不插管状态、谵妄和认知评估转诊）和患者结局（死亡率、再入院和住院时间）的数据。进行了描述性统计和事后功效分析。
干预前和干预后队列分别纳入了 215 例和 191 例患者。干预后，老年病会诊从 3.26%增加到 100%。DNR 和不插管状态的患者从 10.23%增加到 38.22%（p<0.01）。正式认知评估转诊从 2.33%增加到 14.21%（p<0.01），谵妄记录从 31.16%增加到 38.22%（p=0.14）。干预前和干预后住院期间的死亡率和 30 天死亡率分别为 9.30%和 5.24%（p=0.12）和 11.63%和 6.81%（p=0.10）。重症监护病房再入院率分别为 8.26%和 1.96%（p=0.06）。30 天医院再入院率和住院时间无变化。功效分析表明，需要更多的患者才能显示出统计学上的显著结果。
在我们的创伤服务中启动强制性老年病会诊与改善预先护理计划和增加多学科护理有关。确保老年病医生的参与可以帮助减少老年创伤患者的不良结局。
