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One-Year Assessment of Mandatory Geriatric Consults on a Trauma Service
*Olubode A Olufajo, *Samir Tulebaev, *Houman Javedan, *Jonathan Gates, *Maria Duarte, *Justin Wang, Edward Kelly, *Ali Salim, *Zara R Cooper
Brigham and Women's Hospital, Boston, MA
Objective: To assess the effect of mandatory geriatric consults among older trauma patients
Design: Retrospective chart review and prospective observational study
Setting: 793-bed Level I trauma center
Patients: Geriatric (≥70 years) trauma patients managed before the intervention (Jun 2011-Jun 2012) and after the intervention (Oct 2013-Sept 2014)
Interventions: Protocol involving mandatory geriatric consults for geriatric trauma patients (Sept 2013)
Main Outcome Measures: Changes in practice (referral for formal cognitive evaluation, documentation of delirium, geriatric consults) and patient outcomes (in-hospital mortality, 30-day mortality, ICU readmission, hospital readmission)
Results: There were 215 and 191 patients included in the historic and prospective cohorts respectively. In both cohorts, 61% were male, 91% were white, and the mean age was 83 years. The Charlson Co-morbidity Index (1.83 vs. 2.02, P=0.076) and Injury Severity Scores (14.29 vs. 13.56, P=0.254) were similar in both cohorts. Geriatric consults increased from 3.26% before the intervention to 100% after the intervention. Referral for formal cognitive evaluation increased from 2.33% to 14.21% (P<0.001) and delirium documentation increased from 31.16% to 38.22% (P=0.135). In-hospital mortality and 30-day mortality decreased after the intervention (9.30% vs. 5.24%, P=0.118 and 11.63% vs. 6.81%, P=0.096 respectively). There was a clinically significant decrease in ICU readmission with a trend towards statistical significance (8.26% vs. 1.96%, P=0.060) but no change in 30-day hospital readmission (16.92% vs. 14.92%, P=0.596). Power analyses showed more patients were needed to show statistically significant outcomes.
Conclusions: The initiation of mandatory geriatric consults on our trauma service was associated with significant differences in referral patterns as well as improved patient outcomes, particularly ICU readmissions. Developing such protocols may aid in reducing adverse outcomes among geriatric trauma patients.
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