Department of Trauma, University Hospital Zurich, Zurich, Switzerland.
University Zurich, Zurich, Switzerland.
PLoS One. 2021 Jan 11;16(1):e0244554. doi: 10.1371/journal.pone.0244554. eCollection 2021.
Improvements in life expectancy imply that an increase of geriatric trauma patients occurs. These patients require special attention due to their multiple comorbidity issues. The aim of this study was to assess the impact of the implementation of geriatric comanagement (GC) on the allocation and clinical outcome of geriatric trauma patients.
This observational cohort study aims to compare the demographic development and the clinical outcome in geriatric trauma patients (aged 70 years and older) before and after implementation of a certified geriatric trauma center (GC). Geriatric trauma patients admitted between January 1, 2010 and December 31, 2010 were stratified to group pre-GC and admissions between January 1, 2018 and December 31, 2018 to Group post-GC. We excluded patients requiring end-of-life treatment and those who died within 24 h or due to severe traumatic brain injury. Outcome parameters included demographic changes, medical complexity (measured by American Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index (CCI)), in-hospital mortality and length of hospitalization.
This study includes 626 patients in Group pre-GC (mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age 81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC and 5.1 (± 2.0) points in post-GC (p <0.001). In Group pre-GC, 100 patients (16.0%) were stratified as ASA 1 compared with 47 patients (5.6%) in Group post-GC (p <0.001). Group pre-GC had significantly less patients stratified as ASA 3 or higher (n = 235, 37.5%) compared with Group post-GC (n = 389, 46.3%, p <0.001). Length of stay (LOS) decreased significantly from 10.4 (± 20.3) days in Group pre-GC to 7.9 (±22.9) days in Group post-GC (p = 0.011). The 30-day mortality rate was comparable amongst these groups (pre-GC 8.8% vs. post-GC 8.9%).
This study appears to support the implementation of a geriatric trauma center, as certain improvements in the patient care were found: Despite a higher CCI and a higher number of patients with higher ASA classifications, Hospital LOS, complication rates and mortality did were not increased after implementation of the CG. The increase in the case numbers supports the fact that a higher degree of specialization leads to a response by admitting physicians, as it exceeded the expectable trend of demographic ageing. We feel that a larger data base, hopefully in a multi center set up should be undertaken to verify these results.
预期寿命的提高意味着老年创伤患者数量的增加。这些患者由于存在多种合并症问题，因此需要特别关注。本研究的目的是评估老年共管（GC）的实施对老年创伤患者的分配和临床结果的影响。
本观察性队列研究旨在比较在实施经过认证的老年创伤中心（GC）前后，70 岁及以上老年创伤患者（GC）的人口统计学发展和临床结果。2010 年 1 月 1 日至 2010 年 12 月 31 日收治的老年创伤患者分为 GC 前组和 2018 年 1 月 1 日至 2018 年 12 月 31 日收治的 GC 后组。我们排除了需要临终治疗和入院后 24 小时内死亡或因严重创伤性脑损伤死亡的患者。结局参数包括人口统计学变化、医疗复杂性（以美国麻醉医师协会评分（ASA）和 Charlson 合并症指数（CCI）衡量）、院内死亡率和住院时间。
本研究包括 GC 前组 626 例（平均年龄 80.3±6.7 岁）和 GC 后组 841 例（平均年龄 81.1±7.3 岁）。GC 前组中 244 例（39.0%）为男性，GC 后组中 361 例（42.9%）为男性。GC 前组的 CCI 平均为 4.7（±1.8）分，GC 后组为 5.1（±2.0）分（p<0.001）。GC 前组中有 100 例（16.0%）患者被分为 ASA 1 级，而 GC 后组中只有 47 例（5.6%）患者被分为 ASA 1 级（p<0.001）。GC 前组中 ASA 3 级或更高分级的患者明显少于 GC 后组（n=235，37.5%比 n=389，46.3%，p<0.001）。GC 前组的住院时间（LOS）从 10.4（±20.3）天显著缩短至 GC 后组的 7.9（±22.9）天（p=0.011）。这些组的 30 天死亡率相当（GC 前组 8.8%比 GC 后组 8.9%）。
本研究似乎支持老年创伤中心的实施，因为在患者护理方面发现了某些改善：尽管 CCI 更高，ASA 分级更高的患者数量更多，但在实施 CG 后，住院时间（LOS）、并发症发生率和死亡率并未增加。病例数量的增加支持这样一个事实，即更高程度的专业化会促使主治医生做出反应，因为这超出了预期的人口老龄化趋势。我们认为，应在多中心环境中建立更大的数据库，以验证这些结果。
