Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Complications in low-risk older adult trauma patients

A case-control study

Tessler, Robert A., MD, MPH; Rangel, Melissa M., BS; Rosser, Micaela L., BS; Rivara, Frederick P., MD, MPH; Bulger, Eileen, MD; Vavilala, Monica S., MD; Reed, May J., MD; Arbabi, Saman, MD, MPH

Journal of Trauma and Acute Care Surgery: May 2019 - Volume 86 - Issue 5 - p 858–863
doi: 10.1097/TA.0000000000002204
ORIGINAL ARTICLES
Buy
SDC

BACKGROUND Although some geriatric trauma patients may be at low risk of complications, poor outcomes are pronounced if complications do occur. Prevention in this group decreases the risk of excess morbidity and mortality.

METHODS We performed a case-control study of trauma patients 65 years or older treated from January 2015 to August 2016 at a Level I trauma center with a Trauma Quality Improvement Program–predicted probability of complication of less than 20%. Cases had one of the following complications: unplanned admission to the intensive care unit (ICU), unplanned intubation, pneumonia, or unplanned return to the operating room. Two age-matched controls were randomly selected for each case. We collected information on comorbidities, home medications, and early medical care and calculated odds ratios using multivariable conditional logistic regression.

RESULTS Ninety-four patients experienced unplanned admission to ICU (n = 51), unplanned intubation (n = 14), pneumonia (n = 21), and unplanned return to the operating room (n = 8). The 188 controls were more frequently intubated and had higher median ISS but were otherwise similar to cases. The adjusted odds of complication were higher for patients on a home β-blocker (adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.2–4.0) and home anticoagulation (aOR, 2.2; 95% CI, 1.2–4.1). Patients with diabetes (aOR 2.0; 95% CI, 1.1–3.7) and dementia (aOR, 2.0; 95% CI, 1.0–4.3) also had higher odds of complication. The adjusted odds of complication for patients receiving geriatrics consultation was 0.4 (95% CI, 0.2–1.0; p = 0.05). Pain service consultation and indwelling pain catheter placement may be protective, but CIs included 1. There was no association between opiates, benzodiazepines, fluid administration, or blood products in the first 24 hours and odds of complication.

CONCLUSIONS Geriatrics consultation was associated with lower odds of unplanned admission to the ICU, unplanned intubation, pneumonia, and unplanned return to the operating room in low-risk older adult trauma patients. Pathways that support expanding comanagement strategies with geriatricians are needed.

LEVEL OF EVIDENCE Therapeutic/Care management, Level IV.

From the Harborview Injury Prevention and Research Center (R.A.T., F.P.R., E.B., M.S.V., S.A.), Seattle, Washington; School of Medicine (M.M.R., M.L.R.), University of Washington, Seattle, Washington; Department of Pediatrics (F.P.R.), University of Washington, Seattle, Washington; Department of Surgery (E.B., S.A), University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine (M.S.V.), University of Washington, Seattle, Washington; and Division of Gerontology and Geriatric Medicine (M.J.R.), University of Washington, Seattle, Washington.

Submitted: May 21, 2018, Revised: December 9, 2018, Accepted: December 26, 2018, Published online: January 10, 2019.

Address for reprints: Robert A. Tessler, MD, MPH, Harborview Injury Prevention and Research Center, 401 Broadway, 4th Floor, Seattle, WA 98122; email: rtessler@uw.edu; robert.tessler@gmail.com.

This study was presented at the American Association for the Surgery of Trauma Annual Meeting in San Diego, California; September 26 to 29; 2018.

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).

© 2019 Lippincott Williams & Wilkins, Inc.