Timing and methods of frailty assessments in geriatric trauma patients: A systematic review

Cubitt, Mya; Downie, Emma; Shakerian, Rose; Lange, Peter; Cole, Elaine

doi:10.1016/j.injury.2019.07.026

Cited by 30 publications

(25 citation statements)

References 80 publications

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“…The median GCS on presentation was 15 [14][15]. In terms of injury parameters, the median ISS was 9 [4][5][6][7][8][9][10][11][12][13][14][15][16], head-AIS 2 [1][2][3][4], chest-AIS 2 [2][3], abdomen-AIS 1 [1][2] and extremity-AIS 2 [2][3]. Blunt injuries were the most common mechanism of injury (98%).…”

Section: Resultsmentioning

confidence: 99%

Racial and Ethnic Disparities in Frail Geriatric Trauma Patients

et al. 2021

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Background Frailty in geriatric trauma patients is commonly associated with adverse outcomes. Racial disparities in geriatric trauma patients are previously described in the literature. We aimed to assess whether race and ethnicity influence outcomes in frail geriatric trauma patients. Methods We performed a 1-year (2017) analysis of TQIP including all geriatric (age C 65 years) trauma patients. The frailty index was calculated using 11-variables and a cutoff limit of 0.27 was defined for frail status. Multivariate regression analysis was performed to control for demographics, insurance status, injury parameters, vital signs, and ICU and hospital length of stay. Results We included 41,111 frail geriatric trauma patients. In terms of race, among frail geriatric trauma patients, 35,376 were Whites and 2916 were African Americans; in terms of ethnicity, 37,122 were Non-Hispanics and 2184 were Hispanics. On regression analysis, the White race was associated with higher odds of mortality (OR, 1.5; 95% CI, 1.2-2.0; p \ 0.01) and in-hospital complications (OR, 1.4; 95% CI, 1.1-1.9; p \ 0.01). White patients were more likely to be discharged to SNF (OR, 1.2; 95% CI, 1.1-1.4; p = 0.03) and less likely to be discharged home (p = 0.04) compared to African Americans. Non-Hispanics were more likely to be discharged to SNF (OR, 1.3; 95% CI, 1.1-1.5; p \ 0.01) and less likely to be discharged home (p \ 0.01) as compared to Hispanics. No significant difference in in-hospital mortality was seen between Hispanics and Non-Hispanics. Conclusion Race and ethnicity influence outcomes in frail geriatric trauma patients. These disparities exist regardless of age, gender, injury severity, and insurance status. Further studies are needed to highlight disparities by race and ethnicity and to identify potentially modifiable risk factors in the geriatric trauma population.

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Section: Resultsmentioning

confidence: 99%

Racial and Ethnic Disparities in Frail Geriatric Trauma Patients

et al. 2021

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“…These may be useful in development of elderly-specific triage tools and are an avenue for research [ 37 ]. Furthermore, there is an increasing recognition that frailty and sarcopenia are associated with adverse outcome following trauma [ 38 , 39 ]. Indeed frailty assessments appear superior to age in predicting outcome [ 40 ], however no published triage tools utilised frailty scoring.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of elderly specific pre-hospital trauma triage criteria: a systematic review

Boulton

Peel

Rahman

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Pre-hospital identification of major trauma in elderly patients is key for delivery of optimal care, however triage of this group is challenging. Elderly-specific triage criteria may be valuable. This systematic review aimed to summarise the published pre-hospital elderly-specific trauma triage tools and evaluate their sensitivity and specificity and associated clinical outcomes. Methods MEDLINE and EMBASE databases were searched using predetermined criteria (PROSPERO: CRD42019140879). Two authors independently assessed search results, performed data extraction, risk of bias and quality assessments following the Grading of Recommendations, Assessment, Development and Evaluation system. Results 801 articles were screened and 11 studies met eligibility criteria, including 1,332,300 patients from exclusively USA populations. There were eight unique elderly-specific triage criteria reported. Most studies retrospectively applied criteria to trauma databases, with few reporting real-world application. The Ohio Geriatric Triage Criteria was reported in three studies. Age cut-off ranged from 55 to 70 years with ≥ 65 most frequently reported. All reported existing adult criteria with modified physiological parameters using higher thresholds for systolic blood pressure and Glasgow coma scale, although the values used varied. Three criteria added co-morbidity or anti-coagulant/anti-platelet use considerations. Modifications to anatomical or mechanism of injury factors were used by only one triage criteria. Criteria sensitivity ranged from 44 to 93%, with a median of 86.3%, whilst specificity was generally poor (median 54%). Scant real-world data showed an increase in patients meeting triage criteria, but minimal changes to patient transport destination and mortality. All studies were at risk of bias and assessed of “very low” or “low” quality. Conclusions There are several published elderly-specific pre-hospital trauma triage tools in clinical practice, all developed and employed in the USA. Consensus exists for higher thresholds for physiological parameters, however there was variability in age-cut offs, triage criteria content, and tool sensitivity and specificity. Although sensitivity was improved over corresponding ‘adult’ criteria, specificity remained poor. There is a paucity of published real-world data examining the effect on patient care and clinical outcomes of elderly-specific triage criteria. There is uncertainty over the optimal elderly triage tool and further study is required to better inform practice and improve patient outcomes.

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“…Despite this limitation, the exploration of experience in this sample of participants who were predominately older (>60 years) is valid, as previous research has highlighted the need to explore the experiences of BTI in this older population (Baker & Lee, 2016;Cubitt et al, 2019). Although the findings reported in this study are not generalizable to the BTI population, it is likely that the experiences of these participants are applicable to other BTI patients and the quality and safety issues identified in this study are not unique to this sample alone.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The processes of hospital discharge and recovery after blunt thoracic injuries: The patient’s perspective

et al. 2021

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Aims The aim of this study was to explore hospital discharge processes and the self‐management of recovery in the early post‐discharge period after blunt thoracic injury from a patient perspective. Design Qualitative interview study. Methods Interviews were conducted with participants recruited from 8 sites across England and Wales between November 2019–May 2020. Semi‐structured interviews were conducted between 5–8 weeks after hospital discharge, and in total, 14 interviews were undertaken. These interviews were recorded, transcribed and analysed using thematic coding. Results Three main themes were identified from the analysis: (a) challenges in the discharge process, (b) coping at home after discharge and (c) managing medications at home. Pain was a dominant thread running throughout all themes which represented an important quality and safety concern for all participants. Associated concerns included insufficient preparation and education for hospital discharge, ineffective communication and subsequent unsafe use of opioids at home highlighting unmet patient care needs.

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Timing and methods of frailty assessments in geriatric trauma patients: A systematic review

Cited by 30 publications

References 80 publications

Racial and Ethnic Disparities in Frail Geriatric Trauma Patients

Racial and Ethnic Disparities in Frail Geriatric Trauma Patients

Evaluation of elderly specific pre-hospital trauma triage criteria: a systematic review

The processes of hospital discharge and recovery after blunt thoracic injuries: The patient’s perspective

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