Can We Stratify Quality and Cost for Older Patients With Proximal and Midshaft Humerus Fractures?

Abstract

Introduction: This study sought to investigate whether a validated trauma triage tool can stratify hospital quality measures and inpatient cost for middle-aged and geriatric trauma patients with isolated proximal and midshaft humerus fractures. Materials and Methods: Patients aged 55 and older who sustained a proximal or midshaft humerus fracture and required inpatient treatment were included. Patient demographic, comorbidity, and injury severity information was used to calculate each patient’s Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA). Based on scores, patients were stratified to create minimal, low, moderate, and high risk groups. Outcomes included length of stay, complications, operative management, ICU/SDU-level care, discharge disposition, unplanned readmission, and index admission costs. Results: Seventy-four patients with 74 humerus fractures met final inclusion criteria. Fifty-eight (78.4%) patients presented with proximal humerus and 16 (21.6%) with midshaft humerus fractures. Mean length of stay was 5.5 ± 3.4 days with a significant difference among risk groups (P = 0.029). Lower risk patients were more likely to undergo surgical management (P = 0.015) while higher risk patients required more ICU/SDU-level care (P < 0.001). Twenty-six (70.3%) minimal risk patients were discharged home compared to zero high risk patients (P = 0.001). Higher risk patients experienced higher total inpatient costs across operative and nonoperative treatment groups. Conclusion: The STTGMA tool is able to reliably predict hospital quality measures and cost outcomes that may allow hospitals and providers to improve value-based care and clinical decision-making for patients presenting with proximal and midshaft humerus fractures. Level of Evidence: Prognostic Level III.

Diagnostic Accuracy of a Trauma Risk Assessment Tool Among Geriatric Patients With Crash Injuries

“…However, the point estimates of the odds ratio significantly increased as the risk level increased. Earlier studies have reported similar dose-response patterns when either high-or low-energy STTGMA scores were used to assess the occurrence of complications and length of stay among older patients with tibial shaft and plateau fractures, 21 midshaft humeral fractures, 23 hip fractures, 36 and ankle fractures. 37 Our study has added to the growing body of literature on the diagnostic accuracy of the STTGMA in predicting the clinical trajectory among middle age and older adults involved in motor vehicle crash injuries.…”

Trauma Risk Score Also Predicts Blood Transfusion Requirements in Hip Fracture Patients

“…16 Furthermore, the model's predictive ability has also been validated in several other patient populations such as hip, femur, and humerus fracture patients. [10][11][12][13][14] In the clinical setting, the STTGMA tool has the potential to aid clinicians in providing more value-based care. 10,14,15,17 Healthcare providers can use the score early in a patient's admission to gain insight into what the trajectory of the patient's hospital course may look like.…”

“…[10][11][12][13][14] In the clinical setting, the STTGMA tool has the potential to aid clinicians in providing more value-based care. 10,14,15,17 Healthcare providers can use the score early in a patient's admission to gain insight into what the trajectory of the patient's hospital course may look like. Using risk groups similar to the ones used in this study, clinicians can triage patients into more cost-effective standardized care pathways based on their risk group.…”

“…16 Furthermore, the model’s predictive ability has also been validated in several other patient populations such as hip, femur, and humerus fracture patients. 10-14…”

“…Since its development, studies have also shown STTGMA to successfully risk stratify additional outcomes such as need for ICU, length of stay, readmissions, and hospital costs in hip, ankle, tibia, and humerus fracture patients. [10][11][12][13][14][15][16][17] Clinicians can use these scores to identify high risk patients who may benefit from a higher level of care.…”