Evidence-based review of trauma center care and routine palliative care processes for geriatric trauma patients; A collaboration from the American Association for the Surgery of Trauma Patient Assessment Committee, the American Association for the Surgery of Trauma Geriatric Trauma Committee, and the Eastern Association for the Surgery of Trauma Guidelines Committee

Hiba Abdel Aziz, John Lunde, Robert Barraco, John J. Como, Zara Cooper, Thomas Hayward, Franchesca Hwang, Lawrence Lottenberg, Caleb Mentzer, Anne Mosenthal, Kaushik Mukherjee, Joshua Nash, Bryce Robinson, Kristan Staudenmayer, Rebecca Wright, James Yon, Marie Crandall

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

BACKGROUND Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients. METHODS A priori questions were created regarding outcomes for patients 65 years or older with respect to care at trauma centers versus nontrauma centers and use of routine palliative care processes. A query of MEDLINE, PubMed, Cochrane Library, and EMBASE was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to perform a systematic review and create recommendations. RESULTS We reviewed seven articles relevant to trauma center care and nine articles reporting results on palliative care processes as they related to geriatric trauma patients. Given data quality and limitations, we conditionally recommend trauma center care for the severely injured geriatric trauma patients but are unable to make a recommendation on the question of routine palliative care processes for geriatric trauma patients. CONCLUSIONS As our older adult population increases, injured geriatric patients will continue to pose challenges for care, such as comorbidities or frailty. We found that trauma center care was associated with improved outcomes for geriatric trauma patients in most studies and that utilization of early palliative care consultations was generally associated with improved secondary outcomes, such as length of stay; however, inconsistency and imprecision prevented us from making a clear recommendation for this question. As caregivers, we should ensure adequate support for trauma systems and palliative care processes in our institutions and communities and continue to support robust research to study these and other aspects of geriatric trauma. LEVEL OF EVIDENCE Systematic review/guideline, level III.

Original languageEnglish (US)
Pages (from-to)737-743
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number4
DOIs
StatePublished - Apr 1 2019

Keywords

  • Evidence-based medicine
  • geriatric trauma
  • palliative care
  • practice management guideline
  • trauma systems

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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