Background: Older adults presenting with trauma have worse outcomes than younger adults with similar injury severity. In 2013, the American College of Surgeons Trauma Quality Improvement Program published guidelines that recommended geriatrics consultation (GC) for high-risk older adults. Many trauma centers implemented GC in congruence with these guidelines, but the impact on patient outcomes is not well studied. In 2016, Geriatrics Hospitalists who are part of the Hospital Medicine division began providing GC to older adults admitted to the Trauma service at our institution. We aimed to analyze the impact of GC on patient outcomes.
Methods: We performed a retrospective cohort study at an academic Level 1 trauma center. Patients were identified from our hospital Trauma Registry and were at least 65 years old and hospitalized between 2016 to 2022; additional information was abstracted from the electronic health record. Baseline data included age, gender, race, mechanism of injury, injury severity score (ISS), admitting service, length of ICU stay, Charlson comorbidity score, and delirium diagnosis. Patients admitted to the Trauma service, which is staffed by general surgeons, received a GC if they were ≥ 75 years old or ≥ 65 with Frail Scale ≥ 3. Patients admitted to other services, such as orthopedics, spine, or neurosurgery did not receive a GC. We compared patients who received GC with those who did not receive GC. Cohorts were matched for age, race, sex, ISS, and year of admission. Outcome variables included mortality (hospital, 30-day and 90-day), length of stay, discharge destination and readmission rates (30-day and 90-day). Hospital length of stay was compared using a Poisson regression model with propensity matching.
Results: Participants were similar in age, race, sex, and year of admission. ISS was statistically different between cohorts, but the difference was not clinically significant (median 10 for GC vs 9 for non-GC, range 1-50, p < 0.001). Charlson comorbidity score was similar between cohorts. GC patients had higher rates of ICU stay (77.4% vs 65.7%, p < 0.001) and delirium (22.2% vs 14.3%, p < 0.001) compared to non-GC patients. GC was associated with lower hospital mortality (2.3% vs 6.9%, p < 0.001) and increased admission to skilled nursing facility (55.9% vs 48.8%, p < 0.001). Length of stay was higher for GC patients (median 6 vs 4 days, p < 0.001). When adjusted for delirium, Charlson comorbidity score, and ICU stay, 30-day mortality odds were 2.07 times higher (95% CI 1.36-3.14, p = 0.001) and 90-day mortality was 1.61 times higher (95% CI 1.2-2.18, p = 0.002) for non-GC compared to GC. The cohorts did not differ in 30-day (15.3% [GC] vs 16.6% [non-GC], p = 0.34) and 90-day (25.4% [GC] vs 25.1% [non-GC], p = 0.86) readmission rates.
Conclusions: Geriatrics consultation demonstrated impact with a significant reduction in mortality but no difference in readmission rates. Conversely, non-GC patients had shorter length of stay and were more likely to discharge home. GC patients had more medical complexity than non-GC patients, as they had higher ISS and rates of ICU stay and delirium that validates the present criterion ability to identify frail older adults. Expansion of Geriatrics consultation services to other surgical services need to be considered.