Abstract：
BACKGROUND: Increasing numbers of older patients are presenting to the ED following trauma. These patients require multidisciplinary care that the traditional trauma model fails to provide. A Silver Trauma Review Clinic (STRC) was developed in conjunction with the geriatric ED and multidisciplinary services to improve the post-discharge care of patients with non-operative traumatic injuries.We aimed to assess the STRC by reviewing the journey and outcomes of patients who attended the clinic.
METHODS: A retrospective review of electronic chart data was performed on all patients who attended the clinic over the initial 1-year period. Data were collected on patient demographics, medical history, medications, timelines, trauma assessments and further investigations, fracture types, occult injuries, geriatric assessments (Comprehensive Geriatric Assessment, Clinical Frailty Scale, bone health, falls, Orthostatic Hypotension (OH), cognitive screening, mobility), number of reviews and discharge destination.
RESULTS: 137 patients were reviewed with a median age of 80 years (IQR 74-86) and 69% were female. The median Clinical Frailty Scale was 3 with a median time from the patient\'s initial ED presentation to clinic of 15 days (IQR 9.75-21) and median time from initial review to discharge 20 days (IQR 1-35). 71% of presentations were as a result of falls under 2 m. Tertiary survey in the STRC identified previously unrecognised injuries in 24 patients (18%). In total, 56 patients were reviewed with vertebral fractures. 87% of these patients (n=49) were further investigated with a CT or MRI and 95% of patients (n=53) were referred for physiotherapy. Patients attending the STRC had a comprehensive geriatric assessment with abnormal Mini-Cog assessments found in 29%, a new diagnosis of osteoporosis in 43% and orthostatic hypotension diagnosed in 13% of patients. 61% were discharged to primary care and 19% linked into a specialist geriatric clinic.
CONCLUSIONS: The STRC is a novel approach allowing timely, patient-focused, comprehensive and collaborative trauma care of older patients following non-operative injuries.
METHODS: A retrospective review of electronic chart data was performed on all patients who attended the clinic over the initial 1-year period. Data were collected on patient demographics, medical history, medications, timelines, trauma assessments and further investigations, fracture types, occult injuries, geriatric assessments (Comprehensive Geriatric Assessment, Clinical Frailty Scale, bone health, falls, Orthostatic Hypotension (OH), cognitive screening, mobility), number of reviews and discharge destination.
RESULTS: 137 patients were reviewed with a median age of 80 years (IQR 74-86) and 69% were female. The median Clinical Frailty Scale was 3 with a median time from the patient\'s initial ED presentation to clinic of 15 days (IQR 9.75-21) and median time from initial review to discharge 20 days (IQR 1-35). 71% of presentations were as a result of falls under 2 m. Tertiary survey in the STRC identified previously unrecognised injuries in 24 patients (18%). In total, 56 patients were reviewed with vertebral fractures. 87% of these patients (n=49) were further investigated with a CT or MRI and 95% of patients (n=53) were referred for physiotherapy. Patients attending the STRC had a comprehensive geriatric assessment with abnormal Mini-Cog assessments found in 29%, a new diagnosis of osteoporosis in 43% and orthostatic hypotension diagnosed in 13% of patients. 61% were discharged to primary care and 19% linked into a specialist geriatric clinic.
CONCLUSIONS: The STRC is a novel approach allowing timely, patient-focused, comprehensive and collaborative trauma care of older patients following non-operative injuries.
摘要：
背景：越来越多的老年患者在创伤后出现ED。这些患者需要传统创伤模型无法提供的多学科护理。与老年ED和多学科服务相结合，开发了银色创伤审查诊所（STRC），以改善非手术创伤患者的出院后护理。我们旨在通过回顾参加诊所的患者的旅程和结果来评估STRC。
方法：对所有在最初1年期间就诊的患者进行电子图表数据的回顾性分析。收集了患者人口统计学数据，病史,药物,时间线,创伤评估和进一步调查，骨折类型,隐匿性损伤,老年评估(老年综合评估，临床虚弱量表，骨骼健康,falls,体位性低血压(OH),认知筛查，移动性)，评论数量和出院目的地。
结果：137例患者的中位年龄为80岁（IQR74-86），69％为女性。临床衰弱量表的中位数为3，从患者初次ED到门诊的中位数时间为15天（IQR9.75-21），从初次检查到出院的中位数时间为20天（IQR1-35）。71％的介绍是由于跌落在2m以下。STRC的三级调查确定了24名患者（18％）的先前未发现的伤害。总的来说,56例患者复查椎体骨折。这些患者中的87％（n=49）接受了CT或MRI进一步检查，95％的患者（n=53）接受了物理治疗。参加STRC的患者进行了全面的老年评估，发现29％的Mini-Cog评估异常，新诊断为43％的骨质疏松症和13％的患者诊断为直立性低血压。61％的人出院到初级保健，19％的人与老年专科诊所联系。
结论：STRC是一种新颖的方法，可以及时，以病人为中心,对非手术损伤后的老年患者进行全面和协作的创伤护理。
方法：对所有在最初1年期间就诊的患者进行电子图表数据的回顾性分析。收集了患者人口统计学数据，病史,药物,时间线,创伤评估和进一步调查，骨折类型,隐匿性损伤,老年评估(老年综合评估，临床虚弱量表，骨骼健康,falls,体位性低血压(OH),认知筛查，移动性)，评论数量和出院目的地。
结果：137例患者的中位年龄为80岁（IQR74-86），69％为女性。临床衰弱量表的中位数为3，从患者初次ED到门诊的中位数时间为15天（IQR9.75-21），从初次检查到出院的中位数时间为20天（IQR1-35）。71％的介绍是由于跌落在2m以下。STRC的三级调查确定了24名患者（18％）的先前未发现的伤害。总的来说,56例患者复查椎体骨折。这些患者中的87％（n=49）接受了CT或MRI进一步检查，95％的患者（n=53）接受了物理治疗。参加STRC的患者进行了全面的老年评估，发现29％的Mini-Cog评估异常，新诊断为43％的骨质疏松症和13％的患者诊断为直立性低血压。61％的人出院到初级保健，19％的人与老年专科诊所联系。
结论：STRC是一种新颖的方法，可以及时，以病人为中心,对非手术损伤后的老年患者进行全面和协作的创伤护理。
