From the Northeastern Ohio University (H.A.A.), Rootstown, Ohio; Orange Park Medical Center (J.L.), Orange Park, Florida; Lehigh Valley Health Network (R.B.), Allentown, Pennsylvania; MetroHealth Medical Center (J.J.C.), Cleveland, Ohio; Harvard University (Z.C.), Cambridge, Massachusetts; Indiana University (T.H.); Rutgers-New Jersey Medical School (F.H., A.M.), Newark, New Jersey; Florida Atlantic University (L.L.), Boca Raton, Florida; Augusta University (C.M.), Augusta, Georgia; Loma Linda University Medical Center (K.M.), Loma Linda, California; Summa Health (J.N.), Akron, Ohio; University of Washington (B.R.), Seattle, WA; Stanford University (K.S.), Stanford, California; Johns Hopkins University (R.W.), Baltimore, MD; Sky Ridge Surgical Center (J.Y.), Lone Tree, Colorado; and University of Florida College of Medicine (M.C.), Jacksonville, Florida.
J Trauma Acute Care Surg. 2019 Apr;86(4):737-743. doi: 10.1097/TA.0000000000002155.
Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients.
A priori questions were created regarding outcomes for patients 65 years or older with respect to care at trauma centers versus nontrauma centers and use of routine palliative care processes. A query of MEDLINE, PubMed, Cochrane Library, and EMBASE was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to perform a systematic review and create recommendations.
We reviewed seven articles relevant to trauma center care and nine articles reporting results on palliative care processes as they related to geriatric trauma patients. Given data quality and limitations, we conditionally recommend trauma center care for the severely injured geriatric trauma patients but are unable to make a recommendation on the question of routine palliative care processes for geriatric trauma patients.
As our older adult population increases, injured geriatric patients will continue to pose challenges for care, such as comorbidities or frailty. We found that trauma center care was associated with improved outcomes for geriatric trauma patients in most studies and that utilization of early palliative care consultations was generally associated with improved secondary outcomes, such as length of stay; however, inconsistency and imprecision prevented us from making a clear recommendation for this question. As caregivers, we should ensure adequate support for trauma systems and palliative care processes in our institutions and communities and continue to support robust research to study these and other aspects of geriatric trauma.
Systematic review/guideline, level III.
尽管人口老龄化和每年老年创伤患者数量的增加，但我们对老年创伤患者最佳实践的理解仍存在差距。我们知道创伤中心的护理通常可以改善受伤患者的预后，而姑息治疗过程可以改善特定疾病的预后，我们的目标是确定这些干预措施对老年创伤患者结局的有效性。
针对 65 岁及以上患者在创伤中心与非创伤中心的护理以及常规姑息治疗过程的使用方面，提出了事先设定的问题。对 MEDLINE、PubMed、Cochrane 图书馆和 EMBASE 进行了查询。排除了社论、病例报告、书籍章节和综述文章。使用 GRADE（推荐评估、制定与评价）方法进行系统评价并提出建议。
我们回顾了七篇与创伤中心护理相关的文章和九篇报告姑息治疗过程结果的文章，这些结果与老年创伤患者有关。鉴于数据质量和局限性，我们有条件地推荐严重受伤的老年创伤患者接受创伤中心护理，但无法就老年创伤患者常规姑息治疗过程的问题提出建议。
随着我们老年人口的增加，受伤的老年患者将继续给护理带来挑战，例如合并症或虚弱。我们发现，在大多数研究中，创伤中心护理与老年创伤患者的结局改善相关，而早期姑息治疗咨询的使用通常与改善次要结局相关，如住院时间；然而，不一致性和不准确性使我们无法对此问题做出明确建议。作为护理人员，我们应该确保在我们的机构和社区中为创伤系统和姑息治疗过程提供足够的支持，并继续支持强有力的研究，以研究这些和其他老年创伤方面的问题。
系统评价/指南，三级。
