Comparison of Geriatric Versus Non-geriatric Trauma Patients With Palliative Care Consultations

Wycech, Joanna; Fokin, Alexander A.; Katz, Jeffrey K.; Viitaniemi, Sari; Menzione, Nicholas; Puente, Ivan

doi:10.1016/j.jss.2021.02.017

Cited by 4 publications

(9 citation statements)

References 24 publications

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“…The most common MOI was falls. This is in line with previous studies and with data from the Center for Disease Control, which report high rates of falls and falls-related hospitalizations in the older adult population 8,11–13 . These findings can be attributed to the altered sensory input, cognition, balance, vision, and hearing 13,14 .…”

Section: Discussionsupporting

confidence: 92%

“…This is in line with previous studies and with data from the Center for Disease Control, which report high rates of falls and falls-related hospitalizations in the older adult population. 8,[11][12][13] These findings can be attributed to the altered sensory input, cognition, balance, vision, and hearing. 13,14 Regular fall risk assessment, and evaluation of hearing, vision, balance, and cognition may reduce these risks.…”

Section: Discussionmentioning

confidence: 99%

“…28-day ICU-free days § 25 [24][25][26] 24 [25][26] 25 [23][24][25][26] 25 [23][24][25][26] 25 [24][25][26] 25 [23][24][25][26] 25 [24][25][26] 0.952 28-day Ventilator-free days ¶ 24 [21][22][23][24][25][26] 23 [20][21][22][23][24][25] 21 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] 22 [11]…”

Section: Discussionmentioning

confidence: 99%

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It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients

Alizai,

Colosimo,

Hosseinpour

et al. 2023

J Trauma Acute Care Surg

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Background Frailty is associated with poor outcomes in trauma patients. However, the spectrum of physiologic deficits, once a patient is identified as frail, is unknown. The aim of this study was to assess the dynamic association between increasing frailty and outcomes among frail geriatric trauma patients. Methods This is a secondary analysis of the American Association of Surgery for Trauma Frailty Multi-institutional Trial. Patients ≥65 years presenting to one of the 17 trauma centers over 3 years (2019-2022) were included. Frailty was assessed within 24 hours of presentation using the trauma-specific frailty index (TSFI) questionnaire. Patients were stratified by TSFI score into six groups: non-frail (<0.12), Grade I (0.12-0.19), Grade II (0.20-0.29), Grade III (0.30-0.39), Grade IV (0.40-0.49), and Grade V (0.50-1). Our Outcomes included in-hospital and 3-month post-discharge mortality, major complications, readmissions, and fall recurrence. Multivariable regression analyses were performed. Results 1,321 patients were identified. The mean (SD) age was 77 (8.6) years and 49% were males. Median [IQR] ISS was 9[5-13] and 69% presented after a low-level fall. Overall, 14% developed major complications and 5% died during the index admission. Among survivors, 1,116 patients had a complete follow-up, 16% were readmitted within 3 months, 6% had a fall recurrence, 7% had a complication, and 2% died within 3 months post-discharge. On multivariable regression, every 0.1 increase in the TSFI score was independently associated with higher odds of index-admission mortality and major complications, and 3 months post-discharge mortality, readmissions, major complications, and fall recurrence. Conclusions The frailty syndrome goes beyond a binary stratification of patients into Non-Frail and Frail and should be considered as a spectrum of increasing vulnerability to poor outcomes. Frailty scoring can be used in developing guidelines, patient management, prognostication, and care discussions with patients and their families. Level of Evidence Level III, Prognostic and Epidemiological

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients

Alizai,

Colosimo,

Hosseinpour

et al. 2023

J Trauma Acute Care Surg

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“…43 Furthermore, a study by Wycech et al found that despite receiving the same injury severity, younger trauma patients had triple the time to PCC, five times the Hospital Length of Stay (HLOS), a higher rate of futile interventions, and received more aggressive treatment. 42 These findings demonstrate the distinct roles of specialist palliative care and primary palliative care in the surgical critical care setting. More complex populations such as geriatric trauma patients who tend to have significant comorbid conditions likely benefit most from specialist palliative care consultation.…”

Section: Integrated Palliative Approachmentioning

confidence: 86%

Palliative Care in the Trauma and Surgical Critical Care Settings: A Narrative Review

Newsome

Sauder

Spardy

et al. 2022

The American Surgeon™

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Background We aimed to conduct a narrative review of available literature to understand the use of palliative care in the trauma and surgical critical care setting. Methods PubMed, EMBASE, and Google Scholar databases were searched for studies investigating the use of palliative care in the trauma and surgical critical care setting. The search included all studies published through January 9th, 2022. The risk of bias of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist tools. Outcomes were summarized in tables and synthesized qualitatively. Results A total of 22 studies were included in this review. Key elements of successful palliative care include communication, shared decision-making, family involvement, pain control, establishing a patient’s prognosis, and end-of-life management. Approaches to implementation based upon these key elements include best-case/worst-case scenarios, consultation trigger systems, and integrated institutional palliative care programs. Palliative care may reduce hospital length of stay, improve symptom management, and increase patient satisfaction, but the impact on mortality is unclear. Conclusion The core elements of palliative care have been identified and palliative care has been shown to improve outcomes in trauma and surgical critical care. However, the approaches for implementation still require development. The underutilization of palliative care for trauma patients reveals the need for refining criteria for use of palliative care and improvement in the education of surgical critical care teams to provide primary palliative care services.

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“…Despite strong recommendations to incorporate goals of care (GOC) conversations early into the care of critically ill and injured adults, prior work has shown underutilization and no research has been done on GOC discussions incorporated into the decision to enact a potentially FTT. [6][7][8][9][10][11] With this in mind, we sought to determine how frequently the physician-tophysician transfer conversation included discussion of GOC in potentially FTT. We hypothesized that physicians would rarely discuss GOC on transfer calls when faced with patients with catastrophic injuries and a potentially FTT.…”

Section: Questionsmentioning

confidence: 99%

Goals of care are rarely discussed prior to potentially futile trauma transfer: Is it okay to say “No”?

Trenga-Schein,

Zonies,

Cook

2023

J Trauma Acute Care Surg

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Background It is unknown how often the physician-to-physician trauma transfer conversation includes a discussion of patient goals of care (GOC). We hypothesized that physicians would rarely discuss GOC on transfer calls when faced with patients with catastrophic injuries. Methods We completed a retrospective case series of trauma patients transferred to an ACS verified level 1 trauma center between 2018 and 2022 who died or were discharged to hospice without surgical intervention within 48 hours. Transfer call recordings were analyzed for GOC conversations. Results A total of 5,562 patients were accepted as transfers and 82 (1.5%) met inclusion criteria. Eighty of the 82 patients had recorded transfer calls and were analyzed. The most common transfer reason was traumatic brain injury (TBI) and need for neurosurgical capabilities (53%) followed by complex multisystem trauma (23%). There was explicit discussion of code status prior to transfer in 20% and a more in depth GOC conversation for 10% patients. Appropriateness of transfer was discussed in 21% and at least one physician expressed explicit concerns of futility for 14%, though all were subsequently transferred. Code status was changed immediately upon arrival for 15% for patients and 19% of patients transferred neurosurgical expertise were deemed to have non-survivable injuries based on the imaging and exam that was unchanged from the referring hospital. Conclusions Among a group of profoundly injured trauma patients at high risk of death, an explicit discussion of GOC occurred in just 10%. This suggests that even when the catastrophic nature of patient injury is understood, transfers still occur, and patients and their families are subjected to an expensive, disruptive, and displacing experience with little to no anticipated benefit. A discussion of GOC and therapeutic objectives should be considered in all severely injured trauma patients prior to transfer. Level of Evidence IV (Observational Retrospective Case Series)

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Comparison of Geriatric Versus Non-geriatric Trauma Patients With Palliative Care Consultations

Cited by 4 publications

References 24 publications

It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients

It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients

Palliative Care in the Trauma and Surgical Critical Care Settings: A Narrative Review

Goals of care are rarely discussed prior to potentially futile trauma transfer: Is it okay to say “No”?

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