Impact of a geriatric consultation service on outcomes in older trauma patients: a before–after study

Abstract

Purpose

Early geriatric involvement is recommended for older trauma patients. We wished to determine the impact of geriatric consultation on mortality, hospital length of stay and discharge disposition in older patients who were admitted to our Level 1 trauma unit.

Methods

We completed a health records review of trauma unit patients, age ≥ 75 years old with Injury Severity Score (ISS) ≥ 12, before (11/2015–10/2017) and after (11/2017–10/2019) implementation of a geriatric trauma consultation initiative. Primary outcomes were mortality, hospital length of stay and discharge destination. Secondary objectives were adherence to the geriatric trauma consult process and identification of geriatric-specific issues. A multivariable analysis controlling for age, gender, multi-morbidity and ISS was undertaken.

Results

157 patients pre-implementation and 172 post-implementation with mean age 83.8 years and 53.8% females were included. Geriatric consultation had no impact on in-hospital mortality [OR 0.70 (95% CI 0.31–1.58)] or length of stay [ß 0.68 (95%CI − 1.35–2.72)]. Patients who received a geriatric consultation were more likely to be discharged home (OR 2.01 (95% CI 1.24–3.24). The adherence to consultation process was 99.4%. Mobility, pain and cognitive impairment were the most common geriatric concerns, identified in 76.6, 61.1 and 50.0% of older trauma patients, respectively.

Conclusion

Older trauma patients that receive geriatric trauma consultation are more likely to be discharged home. Collaboration between trauma and geriatric specialists is beneficial and may lead to meaningful improvements in outcomes for older trauma patients.

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Fig. 1

Data availability

We do not have consent from patients or hospital research ethics boards to share individual case data. We can make summary data available upon request.

Code availability

Available upon request.

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Acknowledgements

We thank Irina Podinic and Vicki Thomson for assisting with the data collection. We are grateful to Mathieu Lebreton (trauma coordinator) and Laura Wilding (geriatric nurse practitioner) for providing enduring support to the initiative.

Funding

This study was funded by a TOHAMO Quality Patient Safety grant from The Ottawa Hospital. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Affiliations

Authors

Contributions

JL and SF conceived the idea. DE, SF and JL developed the protocol. IP and JM completed the data extraction. DE, MJN, SF, LK, JM and JL interpreted and analyzed the data. DE, JL, SF and LK drafted the manuscript with all authors contributing critical revisions and approval of the final manuscript. JL and DE had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Debra Eagles.

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Conflict of interest

None.

Ethical approval

We obtained local Research Ethics Board approval for this study.

Consent to participate

Not applicable.

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Not applicable.

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Lampron, J., Khoury, L., Moors, J. et al. Impact of a geriatric consultation service on outcomes in older trauma patients: a before–after study. Eur J Trauma Emerg Surg (2021). https://doi.org/10.1007/s00068-021-01724-x

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Keywords

  • Trauma
  • Geriatric
  • Mortality
  • Cohort