Hiba Abdel Aziz1, John Lunde, Robert Barraco, John J Como, Zara Cooper, Thomas Hayward, Franchesca Hwang, Lawrence Lottenberg, Caleb Mentzer, Anne Mosenthal, Kaushik Mukherjee, Joshua Nash, Bryce Robinson, Kristan Staudenmayer, Rebecca Wright, James Yon, Marie Crandall. 1. From the Northeastern Ohio University (H.A.A.), Rootstown, Ohio; Orange Park Medical Center (J.L.), Orange Park, Florida; Lehigh Valley Health Network (R.B.), Allentown, Pennsylvania; MetroHealth Medical Center (J.J.C.), Cleveland, Ohio; Harvard University (Z.C.), Cambridge, Massachusetts; Indiana University (T.H.); Rutgers-New Jersey Medical School (F.H., A.M.), Newark, New Jersey; Florida Atlantic University (L.L.), Boca Raton, Florida; Augusta University (C.M.), Augusta, Georgia; Loma Linda University Medical Center (K.M.), Loma Linda, California; Summa Health (J.N.), Akron, Ohio; University of Washington (B.R.), Seattle, WA; Stanford University (K.S.), Stanford, California; Johns Hopkins University (R.W.), Baltimore, MD; Sky Ridge Surgical Center (J.Y.), Lone Tree, Colorado; and University of Florida College of Medicine (M.C.), Jacksonville, Florida.
Abstract
BACKGROUND: Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients. METHODS: A priori questions were created regarding outcomes for patients 65 years or older with respect to care at trauma centers versus nontrauma centers and use of routine palliative care processes. A query of MEDLINE, PubMed, Cochrane Library, and EMBASE was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to perform a systematic review and create recommendations. RESULTS: We reviewed seven articles relevant to trauma center care and nine articles reporting results on palliative care processes as they related to geriatric trauma patients. Given data quality and limitations, we conditionally recommend trauma center care for the severely injured geriatric trauma patients but are unable to make a recommendation on the question of routine palliative care processes for geriatric trauma patients. CONCLUSIONS: As our older adult population increases, injured geriatric patients will continue to pose challenges for care, such as comorbidities or frailty. We found that trauma center care was associated with improved outcomes for geriatric trauma patients in most studies and that utilization of early palliative care consultations was generally associated with improved secondary outcomes, such as length of stay; however, inconsistency and imprecision prevented us from making a clear recommendation for this question. As caregivers, we should ensure adequate support for trauma systems and palliative care processes in our institutions and communities and continue to support robust research to study these and other aspects of geriatric trauma. LEVEL OF EVIDENCE: Systematic review/guideline, level III.
BACKGROUND: Despite an aging population and increasing number of geriatric traumapatients annually, gaps in our understanding of best practices for geriatric traumapatients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric traumapatients. METHODS: A priori questions were created regarding outcomes for patients 65 years or older with respect to care at trauma centers versus nontrauma centers and use of routine palliative care processes. A query of MEDLINE, PubMed, Cochrane Library, and EMBASE was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to perform a systematic review and create recommendations. RESULTS: We reviewed seven articles relevant to trauma center care and nine articles reporting results on palliative care processes as they related to geriatric traumapatients. Given data quality and limitations, we conditionally recommend trauma center care for the severely injured geriatric traumapatients but are unable to make a recommendation on the question of routine palliative care processes for geriatric traumapatients. CONCLUSIONS: As our older adult population increases, injured geriatric patients will continue to pose challenges for care, such as comorbidities or frailty. We found that trauma center care was associated with improved outcomes for geriatric traumapatients in most studies and that utilization of early palliative care consultations was generally associated with improved secondary outcomes, such as length of stay; however, inconsistency and imprecision prevented us from making a clear recommendation for this question. As caregivers, we should ensure adequate support for trauma systems and palliative care processes in our institutions and communities and continue to support robust research to study these and other aspects of geriatric trauma. LEVEL OF EVIDENCE: Systematic review/guideline, level III.
Authors: Lindsay K Haines; Allyson C Cook; Justin S Hatchimonji; Vanessa P Ho; Elle L Kalbfell; Kathleen M O'Connell; Jacinta C Robenstine; Mathias Schlögl; Christine C Toevs; Christopher A Jones; Robert S Krouse; Niels D Martin Journal: J Palliat Med Date: 2021-07 Impact factor: 2.947