Impact of Modified Geriatric Trauma Activation Criteria at an Academic Level I Trauma Center on Cost, a Retrospective Cohort Study
Sandy Roh, Reginald Alouidor, Margaret Siu, Aixa Perez-Caraballo
University of Massachusetts- Baystate Medical Center, Springfield, Massachusetts, United States
Determine the impact of Modified Geriatric Trauma Activation Criteria (MGTAC) at an academic Level I Trauma Center on total cost of care.
We performed a retrospective cohort study of a prospectively collected database from 2014 to 2020 at Baystate Medical Center. Variables including patient characteristics, mechanism of injury, comorbidities, level of trauma activation, length of stay (LOS), injury severity score (ISS), interventions as well as cost at 24 and 48 hours of admission were collected.
Baystate Medical Center is an academic Level I Trauma Center.
Eligible patients included adults ≥65 years old seen as highest-level activation, limited-level activation or trauma consultation during the study period.
Modified Geriatric Trauma Activation (MGTAC) was implemented on 3/1/2017. This renders limited-level activation criteria to the highest-level activation based on age ≥65.
Main Outcome Measure(s)
Continuous variables were reported using means, medians, standard deviations and percentages. Categorical variables were reported using frequencies and percentages. ANOVA was used to compare LOS and ISS between study groups, while chi-square test was used to compare the frequency of outcomes.
Both study groups were similar in size, N=614 for Standard Trauma Activation and N=574 for Modified Geriatric Trauma Activation. Comorbidities and ISS score between two groups did not show any statistical difference, p=0.78 and p=0.35, respectively. There was no statistical significance for mortality between the study groups, p=0.17. Cost in patient care in the first 24 hours before MGTAC was $12,493.60 and after was $14,253.60 with p=0.03, which was statistically significant, with no subsequent statistical difference in cost in the first 48 hours. There was a statistically significant decrease in ICU admissions with implementation of MGTAC with p=0.02. There was no statistical difference between the two groups related to high resource utilization interventions including patients requiring early operative interventions, IR procedures, transfusions or consultations.
Implementation of Modified Geriatric Trauma Activation Criteria (MGTAC) increased the total cost of patient care in the first 24 hours of admission without improving survival for geriatric trauma patients. There was no statistically significant increase in mortality, length of stay, cost of care at 48 hours or high resource utilization interventions on admission such as operative intervention, IR intervention and number of consultations. Interestingly, there was a statistically significant decrease in ICU admissions with implementation of MGTAC, which suggests improvement in undertriage. However, further analysis will need to be performed whether this was planned versus unplanned or early versus delayed ICU admission.
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