The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center
Improvements in life expectancy imply that an increase of geriatric trauma patients occurs. These patients require special attention due to their multiple comorbidity issues. The aim of this study was to assess the impact of the implementation of geriatric comanagement (GC) on the allocation and cli...
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| description | Improvements in life expectancy imply that an increase of geriatric trauma patients occurs. These patients require special attention due to their multiple comorbidity issues. The aim of this study was to assess the impact of the implementation of geriatric comanagement (GC) on the allocation and clinical outcome of geriatric trauma patients.
This observational cohort study aims to compare the demographic development and the clinical outcome in geriatric trauma patients (aged 70 years and older) before and after implementation of a certified geriatric trauma center (GC). Geriatric trauma patients admitted between January 1, 2010 and December 31, 2010 were stratified to group pre-GC and admissions between January 1, 2018 and December 31, 2018 to Group post-GC. We excluded patients requiring end-of-life treatment and those who died within 24 h or due to severe traumatic brain injury. Outcome parameters included demographic changes, medical complexity (measured by American Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index (CCI)), in-hospital mortality and length of hospitalization.
This study includes 626 patients in Group pre-GC (mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age 81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC and 5.1 (± 2.0) points in post-GC (p |
| doi_str_mv | 10.1371/journal.pone.0244554 |
| format | Article |
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This observational cohort study aims to compare the demographic development and the clinical outcome in geriatric trauma patients (aged 70 years and older) before and after implementation of a certified geriatric trauma center (GC). Geriatric trauma patients admitted between January 1, 2010 and December 31, 2010 were stratified to group pre-GC and admissions between January 1, 2018 and December 31, 2018 to Group post-GC. We excluded patients requiring end-of-life treatment and those who died within 24 h or due to severe traumatic brain injury. Outcome parameters included demographic changes, medical complexity (measured by American Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index (CCI)), in-hospital mortality and length of hospitalization.
This study includes 626 patients in Group pre-GC (mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age 81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC and 5.1 (± 2.0) points in post-GC (p <0.001). In Group pre-GC, 100 patients (16.0%) were stratified as ASA 1 compared with 47 patients (5.6%) in Group post-GC (p <0.001). Group pre-GC had significantly less patients stratified as ASA 3 or higher (n = 235, 37.5%) compared with Group post-GC (n = 389, 46.3%, p <0.001). Length of stay (LOS) decreased significantly from 10.4 (± 20.3) days in Group pre-GC to 7.9 (±22.9) days in Group post-GC (p = 0.011). The 30-day mortality rate was comparable amongst these groups (pre-GC 8.8% vs. post-GC 8.9%).
This study appears to support the implementation of a geriatric trauma center, as certain improvements in the patient care were found: Despite a higher CCI and a higher number of patients with higher ASA classifications, Hospital LOS, complication rates and mortality did were not increased after implementation of the CG. The increase in the case numbers supports the fact that a higher degree of specialization leads to a response by admitting physicians, as it exceeded the expectable trend of demographic ageing. We feel that a larger data base, hopefully in a multi center set up should be undertaken to verify these results.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0244554</identifier><identifier>PMID: 33428650</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Aged ; Aged patients ; Aged, 80 and over ; Aging ; Bias ; Biology and Life Sciences ; Care and treatment ; Chi-square test ; Cohort Studies ; Comorbid patients ; Data analysis ; Demographic aspects ; Disease Management ; Editing ; Female ; Fractures ; Geriatric Assessment ; Geriatrics ; Hospital Mortality ; Hospitalization ; Hospitals ; Humans ; Injuries ; Laboratories ; Length of Stay ; Male ; Medical records ; Medicine and Health Sciences ; Methodology ; Mortality ; Nursing homes ; Patients ; Quality management ; Rehabilitation ; Services ; Trauma ; Trauma Centers ; Wounds and injuries ; Wounds and Injuries - epidemiology ; Wounds and Injuries - mortality ; Wounds and Injuries - therapy</subject><ispartof>PloS one, 2021-01, Vol.16 (1), p.e0244554-e0244554</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Halvachizadeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Halvachizadeh et al 2021 Halvachizadeh et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c593t-277a14a81bfcb635e993fe3b0488f13e382f2a4552e5782e0d7db6c1c2fb0d423</citedby><cites>FETCH-LOGICAL-c593t-277a14a81bfcb635e993fe3b0488f13e382f2a4552e5782e0d7db6c1c2fb0d423</cites><orcidid>0000-0003-1393-3232</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799827/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799827/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33428650$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Halvachizadeh, Sascha</creatorcontrib><creatorcontrib>Gröbli, Lea</creatorcontrib><creatorcontrib>Berk, Till</creatorcontrib><creatorcontrib>Jensen, Kai Oliver</creatorcontrib><creatorcontrib>Hierholzer, Christian</creatorcontrib><creatorcontrib>Bischoff-Ferrari, Heike A</creatorcontrib><creatorcontrib>Pfeifer, Roman</creatorcontrib><creatorcontrib>Pape, Hans-Christoph</creatorcontrib><title>The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Improvements in life expectancy imply that an increase of geriatric trauma patients occurs. These patients require special attention due to their multiple comorbidity issues. The aim of this study was to assess the impact of the implementation of geriatric comanagement (GC) on the allocation and clinical outcome of geriatric trauma patients.
This observational cohort study aims to compare the demographic development and the clinical outcome in geriatric trauma patients (aged 70 years and older) before and after implementation of a certified geriatric trauma center (GC). Geriatric trauma patients admitted between January 1, 2010 and December 31, 2010 were stratified to group pre-GC and admissions between January 1, 2018 and December 31, 2018 to Group post-GC. We excluded patients requiring end-of-life treatment and those who died within 24 h or due to severe traumatic brain injury. Outcome parameters included demographic changes, medical complexity (measured by American Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index (CCI)), in-hospital mortality and length of hospitalization.
This study includes 626 patients in Group pre-GC (mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age 81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC and 5.1 (± 2.0) points in post-GC (p <0.001). In Group pre-GC, 100 patients (16.0%) were stratified as ASA 1 compared with 47 patients (5.6%) in Group post-GC (p <0.001). Group pre-GC had significantly less patients stratified as ASA 3 or higher (n = 235, 37.5%) compared with Group post-GC (n = 389, 46.3%, p <0.001). Length of stay (LOS) decreased significantly from 10.4 (± 20.3) days in Group pre-GC to 7.9 (±22.9) days in Group post-GC (p = 0.011). The 30-day mortality rate was comparable amongst these groups (pre-GC 8.8% vs. post-GC 8.9%).
This study appears to support the implementation of a geriatric trauma center, as certain improvements in the patient care were found: Despite a higher CCI and a higher number of patients with higher ASA classifications, Hospital LOS, complication rates and mortality did were not increased after implementation of the CG. The increase in the case numbers supports the fact that a higher degree of specialization leads to a response by admitting physicians, as it exceeded the expectable trend of demographic ageing. We feel that a larger data base, hopefully in a multi center set up should be undertaken to verify these results.</description><subject>Age</subject><subject>Aged</subject><subject>Aged patients</subject><subject>Aged, 80 and over</subject><subject>Aging</subject><subject>Bias</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Chi-square test</subject><subject>Cohort Studies</subject><subject>Comorbid patients</subject><subject>Data analysis</subject><subject>Demographic aspects</subject><subject>Disease Management</subject><subject>Editing</subject><subject>Female</subject><subject>Fractures</subject><subject>Geriatric Assessment</subject><subject>Geriatrics</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Injuries</subject><subject>Laboratories</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical records</subject><subject>Medicine and Health Sciences</subject><subject>Methodology</subject><subject>Mortality</subject><subject>Nursing homes</subject><subject>Patients</subject><subject>Quality management</subject><subject>Rehabilitation</subject><subject>Services</subject><subject>Trauma</subject><subject>Trauma Centers</subject><subject>Wounds and injuries</subject><subject>Wounds and Injuries - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Halvachizadeh, Sascha</au><au>Gröbli, Lea</au><au>Berk, Till</au><au>Jensen, Kai Oliver</au><au>Hierholzer, Christian</au><au>Bischoff-Ferrari, Heike A</au><au>Pfeifer, Roman</au><au>Pape, Hans-Christoph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-01-01</date><risdate>2021</risdate><volume>16</volume><issue>1</issue><spage>e0244554</spage><epage>e0244554</epage><pages>e0244554-e0244554</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Improvements in life expectancy imply that an increase of geriatric trauma patients occurs. These patients require special attention due to their multiple comorbidity issues. The aim of this study was to assess the impact of the implementation of geriatric comanagement (GC) on the allocation and clinical outcome of geriatric trauma patients.
This observational cohort study aims to compare the demographic development and the clinical outcome in geriatric trauma patients (aged 70 years and older) before and after implementation of a certified geriatric trauma center (GC). Geriatric trauma patients admitted between January 1, 2010 and December 31, 2010 were stratified to group pre-GC and admissions between January 1, 2018 and December 31, 2018 to Group post-GC. We excluded patients requiring end-of-life treatment and those who died within 24 h or due to severe traumatic brain injury. Outcome parameters included demographic changes, medical complexity (measured by American Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index (CCI)), in-hospital mortality and length of hospitalization.
This study includes 626 patients in Group pre-GC (mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age 81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC and 5.1 (± 2.0) points in post-GC (p <0.001). In Group pre-GC, 100 patients (16.0%) were stratified as ASA 1 compared with 47 patients (5.6%) in Group post-GC (p <0.001). Group pre-GC had significantly less patients stratified as ASA 3 or higher (n = 235, 37.5%) compared with Group post-GC (n = 389, 46.3%, p <0.001). Length of stay (LOS) decreased significantly from 10.4 (± 20.3) days in Group pre-GC to 7.9 (±22.9) days in Group post-GC (p = 0.011). The 30-day mortality rate was comparable amongst these groups (pre-GC 8.8% vs. post-GC 8.9%).
This study appears to support the implementation of a geriatric trauma center, as certain improvements in the patient care were found: Despite a higher CCI and a higher number of patients with higher ASA classifications, Hospital LOS, complication rates and mortality did were not increased after implementation of the CG. The increase in the case numbers supports the fact that a higher degree of specialization leads to a response by admitting physicians, as it exceeded the expectable trend of demographic ageing. We feel that a larger data base, hopefully in a multi center set up should be undertaken to verify these results.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33428650</pmid><doi>10.1371/journal.pone.0244554</doi><orcidid>https://orcid.org/0000-0003-1393-3232</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-01, Vol.16 (1), p.e0244554-e0244554 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2476828968 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Age Aged Aged patients Aged, 80 and over Aging Bias Biology and Life Sciences Care and treatment Chi-square test Cohort Studies Comorbid patients Data analysis Demographic aspects Disease Management Editing Female Fractures Geriatric Assessment Geriatrics Hospital Mortality Hospitalization Hospitals Humans Injuries Laboratories Length of Stay Male Medical records Medicine and Health Sciences Methodology Mortality Nursing homes Patients Quality management Rehabilitation Services Trauma Trauma Centers Wounds and injuries Wounds and Injuries - epidemiology Wounds and Injuries - mortality Wounds and Injuries - therapy |
| title | The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T03%3A02%3A38IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20effect%20of%20geriatric%20comanagement%20(GC)%20in%20geriatric%20trauma%20patients%20treated%20in%20a%20level%201%20trauma%20setting:%20A%20comparison%20of%20data%20before%20and%20after%20the%20implementation%20of%20a%20certified%20geriatric%20trauma%20center&rft.jtitle=PloS%20one&rft.au=Halvachizadeh,%20Sascha&rft.date=2021-01-01&rft.volume=16&rft.issue=1&rft.spage=e0244554&rft.epage=e0244554&rft.pages=e0244554-e0244554&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0244554&rft_dat=%3Cgale_plos_%3EA648073881%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2476828968&rft_id=info:pmid/33428650&rft_galeid=A648073881&rft_doaj_id=oai_doaj_org_article_c634744e7ee743588f2943431f95dd99&rfr_iscdi=true |