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A Model of Care to Improve Survival of Older Trauma Patients: Geriatrics Co-Management.

Neupane I, Mujahid N, Zhou EP, Monteiro JFG, Lueckel S, Cizginer S, Yildiz F, Raza S, Singh M, Gravenstein S, McNicoll L. A Model of Care to Improve Survival of Older Trauma Patients: Geriatrics Co-Management. The journals of gerontology. Series A, Biological sciences and medical sciences. 2022 Jul 22.

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BACKGROUND: Trauma patients older than 80 years of age have higher mortality rates compared to younger peers. No studies have investigated the effectiveness of geriatrics co-management on mortality in general trauma. METHODS: Retrospective cohort study from 2015-2016 comparing overall and inpatient mortality in a geriatrics trauma co-management (GTC) program versus usual care (UC). Demographic and outcome measures were obtained from the trauma registry at an 11-bed trauma critical care unit within a 719-bed Level 1 Trauma Center. 1,572 patients, 80 years and older, with an admitting trauma diagnosis were evaluated. Primary outcome was in-hospital mortality and overall mortality (defined as inpatient death or discharge to hospice). Secondary outcomes included hospital length of stay (LOS), Intensive Care Unit (ICU) LOS, discharge location, and medical complications. RESULTS: 346 patients (22%) were placed in the GTC program. Overall mortality was lower in the GTC (4.9%) when compared with UC (11.9%), representing a 57% reduction (95% OR CI 0.24-0.75, p-value = 0.0028). There was a 7.42% hospital mortality rate in the UC group compared to 2.6% in the GTC group (95% CI 0.21-0.92, p-value = 0.0285) representing a 56% decrease in in-hospital mortality. GTC patients had a longer mean LOS (6.4 days versus 5.3 days, p-value < 0.0001). More GTC patients were sent to inpatient rehabilitation facilities or skilled nursing facilities (80% versus 60%, p-value < 0.0001). CONCLUSIONS: Geriatrics trauma co-management of trauma patients above the age of 80 may reduce mortality and deserves formal study.

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