背景:老年创伤患者的治疗需要平衡慢性合并症与急性损伤。我们开发了一种护理模式,其中患者由住院医师进行以创伤为中心的教育管理,并假设临床结果与主要由创伤外科医师管理的患者的结果相似。
方法:这是一项对2020年1月至2021年12月年龄≥65岁的创伤患者的回顾性研究。按入院服务定义组:创伤外科服务(TSS)或老年创伤住院医师服务(GTHS)。主要结果是院内死亡率。进行回归分析和逆概率治疗加权(IPTW)倾向评分(PS)分析,以确定入院服务和结果之间的关联。
结果:共有1004名患者符合纳入标准-580GTHS和424TSS入院。GTHS患者年龄较大(82vs.74,p<0.001),更有可能遭受钝性创伤(99.5%vs.95%,p<0.001),更有可能有合并症(91.2%vs.87%,p<0.001),具有较高的Charlson合并症指数(CCIs),并且中位损伤严重程度评分较低(9vs.13,p<0.001)。死亡率,谵妄,重新接纳30天,总体并发症低,组间相似.虽然TSS患者可能会出院回家,GTHS有更多的出院到熟练的护理机构和更长的住院时间(LOS)。根据年龄调整后的多变量分析,ISS,CCI和性别,与TSS相比,GTHS患者的死亡几率较低,比值比为0.15(95%置信区间[CI]0.02-0.75,p=0.03).关于IPTWPS分析,GTHS患者死亡几率相似,比值比为0.3(95%CI0.06~1.6,p=0.16).
结论:与接受TSS的患者相比,将GTHS的入院标准转化为类似的低死亡率,但LOS更长。这种护理模式可能会告知其他创伤中心制定策略,以管理越来越多的易受伤害的老年人。
BACKGROUND: Management of geriatric trauma patients requires balancing chronic comorbidities with acute injuries. We developed a care model in which patients are managed by hospitalists with trauma-centered education and hypothesized that clinical outcomes would be similar to outcomes in patients primarily managed by trauma surgeons.
METHODS: This was a retrospective study of trauma patients aged ≥65 from January 2020 to December 2021. Groups were defined by admitting service: trauma surgery service (TSS) or geriatric trauma hospitalist service (GTHS). The primary outcome was in-hospital mortality. Regression analyses and inverse probability treatment weighted (IPTW) propensity score (PS) analyses were performed to determine the association between admitting service and outcomes.
RESULTS: A total of 1004 patients were eligible for inclusion-580 GTHS and 424 TSS admissions. GTHS patients were older (82 vs. 74, p < 0.001), more likely to have suffered blunt trauma (99.5% vs. 95%, p < 0.001), more likely to have comorbidities (91.2% vs. 87%, p < 0.001), had higher Charlson Comorbidity Indexes (CCIs), and had lower median injury severity scores (9 vs. 13, p < 0.001). Rates of mortality, delirium, 30-day readmission, and overall complications were low and similar between groups. While TSS patients were likely to be discharged home, GTHS had more discharges to skilled nursing facilities and longer length of stay (LOS). On multivariable analysis adjusted for age, ISS, CCI, and sex, patients admitted to GTHS had lower odds of death with an odds ratio of 0.15 (95% confidence interval [CI] 0.02-0.75, p = 0.03) when compared to TSS. On IPTW PS analysis, patients admitted to GTHS had similar odds of death with an odds ratio of 0.3 (95% CI 0.06-1.6, p = 0.16).
CONCLUSIONS: Protocolized admission criteria to a GTHS resulted in similar low mortality rates but longer LOS when compared to patients admitted to a TSS. This care model may inform other trauma centers in developing their strategies for managing the increasing volume of vulnerable injured older adults.