An Evaluation of a Proactive Geriatric Trauma Consultation Service

*Department of Medicine, University of Saskatchewan, Saskatchewan, Canada †Division of Trauma, St. Michael's Hospital ‡Department of Surgery, St. Michael's Hospital §Division of Geriatric Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital ‖Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Annals of surgery (Impact Factor: 8.33). 10/2012; 256(6). DOI: 10.1097/SLA.0b013e318270f27a
Source: PubMed


OBJECTIVE:: To describe and evaluate an inpatient geriatric trauma consultation service (GTCS). BACKGROUND:: Delays in recognizing the special needs of older trauma patients may result in suboptimal care. The GTCS is a proactive geriatric consultation model aimed at preventing and managing age-specific complications and discharge planning for all patients 60 years or older admitted to the St Michael's Hospital Trauma Service. METHODS:: This was a before and after case series of patients admitted pre-GTCS (March 2005-August 2007) and post-GTCS (September 2007-March 2010). Study data were derived from a review of the medical records and from the St Michael's Hospital trauma registry. Abstracted data included demographics, type of geriatric issues addressed, rate of adherence to recommendations made by the GTCS, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests, and discharge destinations. RESULTS:: A total of 238 pre-GTCS patients and 248 post-GTCS patients were identified. The rate of adherence to recommendations made by the GTCS team was 93.2%. There were fewer consultation requests made to Internal Medicine and Psychiatry in the post-GTCS group (N = 31 vs N = 18, P = 0.04; and N = 33 vs N = 18, P = 0.02; respectively). There were no differences in any of the prespecified complications except delirium (50.5% pre-GTCS vs 40.9% post- GTCS, P = 0.05). Among patients admitted from home, fewer were discharged to long-term care facilities among the post-GTCS group (6.5% pre-GTCS vs 1.7% post-GTCS, P = 0.03). CONCLUSIONS:: A proactive geriatric consultation model for elderly trauma patients may decrease delirium and discharges to long-term care facilities. Future studies should include a multicenter randomized trial of this model of care.

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    ABSTRACT: The traumatically injured geriatric patient presents a challenge to the practitioner. Increased morbidity and mortality can result in unique requirements for the treatment of elderly patients. The principles of surgical management of genitourinary injuries remain largely unchanged in the geriatric population. Reconstructive techniques to repair these injuries generally require appropriate evaluation and timing of repair. Fortunately, the treatment of genitourinary injuries in the geriatric population remains largely successful. © 2014 Springer Science+Business Media New York. All rights reserved.
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