Dhanani Hiba, Tabata-Kelly Masami, Jarman Molly, Cooper Zara
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2025 Apr;73(4):1250-1266. doi: 10.1111/jgs.19292. Epub 2024 Dec 10.
Millions of older adults (≥65) present to emergency departments for injury annually. As the population increases, so will the number of older adults admitted for trauma. Although treatment guidelines for older adults who sustain trauma exist, the evidence for quality improvement is limited. The purpose of this scoping review was to identify hospital-based geriatric-centered interventions that improve care for older adults admitted to trauma services.
We searched MEDLINE, EMBASE, and CINAHL to identify studies related to geriatric-centered interventions on trauma surgery services (1993-2023). Five reviewers screened studies for full-text review based on these inclusion criteria: (1) older injured adults and/or their caregivers; (2) hospital-based clinical interventions directed to geriatric trauma patients (e.g., frailty assessments, geriatric co-management, triage criteria); and (3) measuring outcomes associated with geriatric trauma. We used the Donabedian quality improvement framework to categorize interventions as structures or processes.
Of 2243 abstracts, 66 studies met the criteria for full-text review, and 47 were included in the analysis. Most (64%) were single-site retrospective cohort studies at Level 1 trauma centers. The most frequent interventions (not mutually exclusive) included geriatric-centered teams (26%), geriatric consultation (23%), interdisciplinary rounds (17%), and medication review (11%). The most frequently measured clinical outcomes were length of stay (47%), discharge location (26%), and in-hospital mortality (21%). Two studies (4%) measured outcomes beyond 3 months. Patient-reported outcomes were rarely included (4%), and caregiver-specific outcomes were not measured.
This scoping review demonstrates the variability in the types of geriatric-centered interventions on trauma surgery services and their associated outcome measures. Furthermore, this review highlights evidence gaps in existing long-term, post-discharge outcomes and patient-/caregiver-reported outcomes. Given the increasing demand for high-quality geriatric trauma care, our findings emphasize the need for evidence-based national standards for geriatric trauma care and targeted study of outcomes germane to older adults and their caregivers.
每年有数以百万计的老年人（≥65岁）因受伤前往急诊科就诊。随着人口增长，因创伤入院的老年人数量也会增加。尽管存在针对创伤老年患者的治疗指南，但质量改进方面的证据有限。本范围综述的目的是确定以医院为基础的、以老年医学为中心的干预措施，以改善对创伤服务入院老年患者的护理。
我们检索了MEDLINE、EMBASE和CINAHL，以识别与创伤手术服务中以老年医学为中心的干预措施相关的研究（1993 - 2023年）。五名评审员根据以下纳入标准筛选研究以进行全文审查：（1）受伤的老年成年人和/或其照顾者；（2）针对老年创伤患者的基于医院的临床干预措施（如衰弱评估、老年医学共同管理、分诊标准）；（3）测量与老年创伤相关的结果。我们使用Donabedian质量改进框架将干预措施分类为结构或过程。
在2243篇摘要中，66项研究符合全文审查标准，47项纳入分析。大多数（64%）是一级创伤中心的单中心回顾性队列研究。最常见的干预措施（并非相互排斥）包括以老年医学为中心的团队（26%）、老年医学咨询（23%）、多学科查房（17%）和药物审查（11%）。最常测量的临床结局是住院时间（47%）、出院地点（26%）和院内死亡率（21%）。两项研究（4%）测量了3个月以上的结局。患者报告的结局很少被纳入（4%），且未测量照顾者特定的结局。
本范围综述表明，创伤手术服务中以老年医学为中心的干预措施类型及其相关结局测量存在差异。此外，本综述突出了现有长期、出院后结局以及患者/照顾者报告结局方面的证据空白。鉴于对高质量老年创伤护理的需求不断增加，我们的研究结果强调需要基于证据的老年创伤护理国家标准以及针对老年人及其照顾者相关结局的针对性研究。
