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Evidence-based review of trauma center care and routine palliative care processes for geriatric trauma patients; A collaboration from the American Association for the Surgery of Trauma Patient Assessment Committee, the American Association for the Surgery of Trauma Geriatric Trauma Committee, and the Eastern Association for the Surgery of Trauma Guidelines Committee

Aziz, Hiba Abdel, MD; Lunde, John, DNP; Barraco, Robert, MD, MPH; Como, John J., MD, MPH; Cooper, Zara, MD, MSc; Hayward, Thomas III, MD; Hwang, Franchesca, MD, MSc; Lottenberg, Lawrence, MD; Mentzer, Caleb, DO; Mosenthal, Anne, MD; Mukherjee, Kaushik, MD, MSci; Nash, Joshua, DO; Robinson, Bryce, MD, MS; Staudenmayer, Kristan, MD, MS; Wright, Rebecca, PhD; Yon, James, MD; Crandall, Marie, MD, MPH

Journal of Trauma and Acute Care Surgery: April 2019 - Volume 86 - Issue 4 - p 737–743
doi: 10.1097/TA.0000000000002155

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.

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.

Submitted: August 20, 2018, Revised: October 18, 2018, Accepted: November 14, 2018, Published online: December 10, 2018.

Address for reprints: Marie Crandall, MD, MPH, FACS, University of Florida College of Medicine Jacksonville, 655 W 8th St, Jacksonville, FL 32209; email:

© 2019 Lippincott Williams & Wilkins, Inc.