Konda Sanjit R, Dedhia Nicket, Ganta Abhishek, Egol Kenneth A
Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and.
Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY.
J Orthop Trauma. 2020 Oct;34(10):539-544. doi: 10.1097/BOT.0000000000001791.
To determine whether a validated trauma triage tool can identify the middle-aged and geriatric trauma patients with tibial shaft and plateau fractures who are at the risk for costly admissions and poorer hospital quality measures.
Prospective cohort study.
Level-1 trauma center.
PATIENTS/PARTICIPANTS: Sixty-four patients older than 55 years hospitalized with isolated tibial shaft or plateau fractures.
Patients with either isolated tibial plateau fractures or tibial shaft fractures over a 3-year period were prospectively enrolled in an orthopedic trauma registry. Demographic information, injury severity, and comorbidities were assessed and incorporated into the Score for Trauma Triage in Geriatric and Middle Aged (STTGMA) score, a validated trauma triage score that calculates inpatient mortality risk upon admission. Patients were then grouped into tertiles based on their STTGMA score.
Length of stay, complications, discharge location, and direct variable costs.
Sixty-four patients met inclusion criteria. Thirty-three patients (51.6%) presented with tibial plateau fractures and 31 (48.4%) with tibial shaft fractures. The mean age was 66.7 ± 10.2 years. Mean length of stay was significantly different between risk groups with a mean of 6.8 ± 4 days (P < 0.001). Although 19 (90.5%) of the minimal risk patients were discharged home, only 7 (33.3%) and 5 (22.7%) of moderate- and high-risk patients were discharged home, respectively (P < 0.001). Higher-risk patients experienced a significantly greater number of complications during hospitalization but had no differences in the need for intensive care unit-level care (P = 0.027 and P = 0.344, respectively). The total cost difference between the lowest- and highest-risk group was nearly 50% ($14,070 ± 8056 vs. $25,147 ± 14,471; mean difference, $11,077; P = 0.022).
Application of the STTGMA triage tool allows for the prediction of key hospital quality measures and cost of hospitalization that can improve clinical decision-making.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定一种经过验证的创伤分诊工具能否识别出胫骨干和胫骨平台骨折的中老年创伤患者，这些患者存在高额住院费用和较差医院质量指标的风险。
前瞻性队列研究。
一级创伤中心。
患者/参与者：64名年龄超过55岁、因单纯胫骨干或胫骨平台骨折住院的患者。
在3年期间，将单纯胫骨平台骨折或胫骨干骨折的患者前瞻性纳入骨科创伤登记系统。评估人口统计学信息、损伤严重程度和合并症，并将其纳入老年和中年创伤分诊评分（STTGMA），这是一种经过验证的创伤分诊评分，可计算入院时的住院死亡率风险。然后根据患者的STTGMA评分将其分为三分位数组。
住院时间、并发症、出院地点和直接可变成本。
64名患者符合纳入标准。33名患者（51.6%）为胫骨平台骨折，31名患者（48.4%）为胫骨干骨折。平均年龄为66.7±10.2岁。不同风险组的平均住院时间有显著差异，平均为6.8±4天（P<0.001）。虽然最低风险组的19名患者（90.5%）出院回家，但中度和高风险组分别只有7名患者（33.3%）和5名患者（22.7%）出院回家（P<0.001）。高风险患者在住院期间经历的并发症显著更多，但在重症监护病房级护理需求方面无差异（分别为P=0.027和P=0.344）。最低风险组和最高风险组之间的总成本差异近50%（14,070±8056美元对25,147±14,471美元；平均差异为11,077美元；P=0.022）。
应用STTGMA分诊工具可预测关键的医院质量指标和住院费用，从而改善临床决策。
预后III级。有关证据水平的完整描述，请参阅作者须知。
