Tyree Sara, Fischer Karen, Stephens Daniel, Burton M Caroline, Pagali Sandeep
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine Research Hub, Mayo Clinic, Rochester, Minnesota, USA.
J Am Geriatr Soc. 2024 Aug;72(8):2372-2380. doi: 10.1111/jgs.18977. Epub 2024 May 20.
Older adults presenting with trauma have worse outcomes than younger adults. Starting in 2016, we provided geriatrics consultation (GC) to older adults admitted to the trauma service. We aimed to analyze the impact of GC on patient outcomes.
We performed a retrospective pre-post study and year-matched cohort study. We identified patients from the trauma registry at our level 1 trauma center. In the pre-post study, we compared patients who received GC (2016-2022) with controls (2011-2015). In the cohort study (2016-2022), we compared patients who received GC with controls. We matched for age, race, sex, and injury severity score (ISS) in both studies, as well as admission year in the cohort study. Outcome variables included mortality (in-hospital, 30-day, 90-day), length of stay (LOS), discharge disposition, and hospital readmission rates (30-day, 90-day).
We analyzed 1968 patients in the pre-post study and 2544 patients in the cohort study. Patients were similar in age, race, and sex. GC patients had a slightly higher ISS score and a higher rate of ICU stay. Delirium occurrence was lower among GC patients. GC patients had lower in-hospital mortality compared to controls (pre-post OR 0.27, p < 0.001; cohort OR 0.31, p < 0.001) and increased LOS (6 days vs 4 days, p < 0.001; both studies). GC patients in the cohort study also had lower 30- and 90-day mortality (OR 0.52 and 0.65, p < 0.01) and were less likely to return home (OR 0.81, p < 0.01); similar trends, though not statistically significant, were noted in the pre-post study. Lower readmission rates (statistically non-significant) were noted in the GC group across both studies.
GC in older adults with trauma has proven benefit with reduced mortality and a trend toward lower readmission rates but was associated with increased LOS and higher rates of discharge to skilled facility.
与年轻成人相比，遭受创伤的老年成人预后更差。从2016年开始，我们为入住创伤服务科室的老年成人提供老年病咨询（GC）。我们旨在分析GC对患者预后的影响。
我们进行了一项回顾性前后对照研究和年度匹配队列研究。我们从我们的一级创伤中心的创伤登记处识别患者。在前后对照研究中，我们将接受GC的患者（2016 - 2022年）与对照组（2011 - 2015年）进行比较。在队列研究（2016 - 2022年）中，我们将接受GC的患者与对照组进行比较。在两项研究中，我们根据年龄、种族、性别和损伤严重程度评分（ISS）进行匹配，在队列研究中还根据入院年份进行匹配。结局变量包括死亡率（住院、30天、90天）、住院时间（LOS）、出院处置方式和医院再入院率（30天、90天）。
我们在前后对照研究中分析了1968例患者，在队列研究中分析了2544例患者。患者在年龄、种族和性别方面相似。GC组患者的ISS评分略高，入住ICU的比例更高。GC组患者谵妄发生率较低。与对照组相比，GC组患者的住院死亡率较低（前后对照研究中OR为0.27，p < 0.001；队列研究中OR为0.31，p < 0.001），住院时间延长（6天对4天，p < 0.001；两项研究均如此）。队列研究中的GC组患者30天和90天死亡率也较低（OR分别为0.52和0.65，p < 0.01），回家的可能性较小（OR为0.81，p < 0.01）；在前后对照研究中也观察到了类似趋势，尽管无统计学意义。在两项研究中，GC组的再入院率均较低（无统计学意义）。
事实证明，对老年创伤患者进行GC有益，可降低死亡率，并呈现出再入院率降低的趋势，但与住院时间延长和转至专业机构的出院率较高有关。
