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High-risk geriatric protocol: Improving mortality in the elderly

Bradburn, Eric DO, MS; Rogers, Frederick B. MD, MS; Krasne, Margaret BS; Rogers, Amelia BS; Horst, Michael A. PhD, MPHS, MS; Belan, Matthew J. MD; Miller, Jo Ann BSN, RN, CCRN

Journal of Trauma and Acute Care Surgery: August 2012 - Volume 73 - Issue 2 - p 435–440
doi: 10.1097/TA.0b013e31825c7cf4
EAST 2012 PLENARY PAPERS
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BACKGROUND Injured geriatric patients pose unique challenges to the trauma team because of their abnormal responses to shock and injury. We have developed the high-risk geriatric protocol (GP) that seeks to identify high-risk geriatric patients. We hypothesized that a high-risk GP would improve outcome in this select group of patients.

METHODS Patients from 2000 to 2010 were included. Patients 65 years or older who met high-risk GP based on comorbidities and/or physiologic parameters were compared with those patients who had not received GP before its implementation as well as other non-GP patients. This protocol includes a geriatric consultation, as well as a lactate levels, arterial blood gas levels, and echo test to assess for occult shock. Age, trauma activation, preexisting conditions, Injury Severity Score, Revised Trauma Score, and mortality were reviewed. Univariate and multivariate analyses were conducted to identify factors predictive of mortality.

RESULTS A total of 3,902 patients were evaluated. Patients receiving GP were less likely to die (odds ratio, 0.63 [0.39–0.99], p = 0.046). For all patients, there was a dramatic increase in mortality for those patients older than 75 years.

CONCLUSION The GP, adjusted for other covariates, significantly reduced mortality in our patient population. Thus, this study confirms the overall effectiveness of our GP, which is hallmarked by prompt identification of those patients with occult shock and a multidisciplinary care of the aged population.

LEVEL OF EVIDENCE Therapeutic study, level IV.

Supplemental digital content is available in the article.

From the Department of Trauma, Critical Care and Acute Care Surgery, Lancaster General Hospital, Lancaster, Pennsylvania.

Submitted: December 1, 2011, Revised: April 26, 2012, Accepted: April 26, 2012.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

This study was presented at the 25th annual meeting of the Eastern Association for the Surgery of Trauma, January 10–14, 2012, in Lake Buena Vista, Florida.

Address for reprints: Frederick B. Rogers, MD, MS, FACS, Lancaster General Hospital, 555 N. Duke St, Lancaster, PA 17602; email: frogers2@lghealth.org.

© 2012 Lippincott Williams & Wilkins, Inc.