Predicting Length of Stay and Readmissions After an Ankle Fracture Using a Risk Stratification Tool (STTGMA)

Introduction: Distal radius fractures are the second most common fracture in the elderly population. The incidence of these fractures has increased over time, and is projected to continue to do so. The aim of this study is to utilize a validated trauma risk prediction tool to stratify middle-aged and geriatric patients with operative distal radius fractures as well as compare hospital quality metrics and inpatient hospitalization costs among the risk groups. Materials and Methods: Patients were prospectively enrolled in an orthopedic trauma registry. The Score for Trauma Triage in Geriatric and Middle Aged (STTGMA) was calculated using patient demographics, injury severity, and functional status. Patients were then stratified into minimal-risk, moderate-risk, and high-risk cohorts based on their scores. Length of stay, need for escalation of care, complications, mortality, discharge location, 1-year patient reported outcomes, and index admission costs were evaluated. Results: Ninety-two patients met inclusion criteria. Sixty-three (68.5%) patients were managed with outpatient surgery. The mean inpatient length of stay for the high-risk cohort was 2.9x and 2.2x higher than the minimal and moderate-risk cohorts, respectively (2.0 + 2.9 days vs. 0.7 + 0.9 and 0.9 + 1.1 days, P = .019). There were no complications or mortality in any of the risk groups. No patients required intensive care and all patients were discharged home. There was no difference in readmission rates, inpatient cost, or 1-year patient reported outcomes among the risk cohorts. Discussion/Conclusions: The Score for Trauma Triage in Geriatric and Middle-Aged is able to risk-stratify patients that undergo operative intervention of distal radius fractures. Middle aged and elderly patients with isolated closed distal radius fractures can be safely managed on an outpatient basis regardless of risk. Standardized pathways can be created in the management of these injuries, thereby optimizing value-based care. Level of evidence: Prognostic Level III

“…They were also more likely to be discharged to rehab facilities or nursing homes. 34,35 Similar findings have been noted in patients with tibial plateau and tibial shaft fractures. 36…”

Section: Sttgmasupporting

confidence: 77%

Ability of a Risk Prediction Tool to Stratify Quality and Cost for Older Patients With Operative Distal Radius Fractures

Adenikinju

Ranson

Rettig

et al. 2021

“…STTGMA has been validated in the National Trauma Data Bank and in multiple Level 1 Trauma Centers as a reliable risk and cost stratification tool. 14 - 16 These variables included patient age, Glasgow Coma Score (GCS), mechanism of injury, Abbreviated Injury Severity (AIS) sub-scores for the head and neck (AIS-HN), chest (AIS-CHS), and pelvis and extremity (AIS-EXT), as well as Charlson comorbidity index (CCI), ambulatory status, serum albumin levels, use of assistive device, and pre-injury anticoagulation status. Patient demographics, injury severity, and functional status were then utilized to calculate a validated STTGMA score that is reported as a percentage risk of inpatient mortality.…”

Section: Methodsmentioning

confidence: 99%

Who Is the Geriatric Trauma Patient? An Analysis of Patient Characteristics, Hospital Quality Measures, and Inpatient Cost

Konda

Lott

Mandel

et al. 2020

Purpose: The purpose of this study was 2-fold: 1) to investigate the age-related frequency, demographics and distribution of the middle-aged and geriatric orthopedic trauma population and 2) to describe the age-related frequency and distribution of hospital quality measure outcomes and inpatient cost. Methods: All patients > 55 years of age who required orthopedic, trauma, or neurosurgery consults at 3 hospitals within an academic medical center from 2014 to 2017 were prospectively followed. On initial evaluation, each patient’s demographics, injury severity, and functional status were collected. Patients were grouped into low and high-energy mechanism cohorts and divided into 5 groups based on age. Hospital quality measures including length of stay, complications, discharge location, and cost of care was compared between age groups. Data were analyzed using ANOVA and Chi-square tests. Results: A total of 3965 patients were included in this study of which 3268 (82%) sustained low-energy trauma and 697 (18%) sustained high-energy trauma. With increasing age, more patients had more comorbidities, were less likely to be community ambulators, and more likely to use assistive devices (p < 0.05). Patients in older age groups had longer lengths of stay, more complications, were more likely to need ICU level care, and were less likely to be discharged home (p < 0.05). Rates of mortality were also greater in patients of more advanced age in both low and high-energy cohorts, and the calculated risk triage tool (STTGMA) score increased with each age bracket (p < 0.05). Total cost of care differed between age groups in the low-energy cohort (p = 0.003). Conclusion: This epidemiological study provides a clear picture of the frequency and distribution of demographic, physiologic characteristics, outcomes, and cost of care in a middle-aged and geriatric orthopedic trauma population as evaluated by the STTGMA risk tool. Risk profiling of geriatric trauma patients allows for the establishment of baseline norms.

“…15 Another study of ankle fracture patients concluded STTGMA is also able to identify patients at risk of being readmitted following discharge from their index hospitalization. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Konda

Perskin

Parola

et al. 2021

Introduction The purpose of this study is to determine if the risk of receiving a blood transfusion during hip fracture hospitalization can be predicted by a validated risk profiling score (Score for Trauma Triage in Geriatric and Middle Aged (STTGMA)). Materials and Methods A consecutive series of 1449 patients 55 years and older admitted for a hip fracture at one academic medical center were identified from a trauma database. The STTGMA risk score was calculated for each patient. Patients were stratified into risk groups based on their STTGMA score quantile: minimal risk (0–50%), low risk (50–80%), moderate risk (80–95%), and high risk (95–100%). Incidence and volume of blood transfusions were compared between risk groups. Results There were 562 (38.8%) patients who received a transfusion during their admission. 58.3% of patients in the high risk group received a transfusion during admission compared to 31.2% of minimal risk group patients, 42.6% of low risk group patients, and 50.0% of moderate risk group patients ( p < 0.001). STTGMA was predictive of first transfusion incidence in both the preoperative and postoperative periods. There was no difference in mean total transfusion volume between the four risk groups. Conclusion The STTGMA model is capable of risk stratifying hip fracture patients more likely to receive blood transfusions during hospitalization. Surgeons can use this tool to anticipate transfusion requirements.