Impact of inpatient geriatrics consultation on hospital outcomes in older adults with trauma

Sara Tyree; Karen Fischer; Daniel Stephens; M Caroline Burton; Sandeep Pagali

doi:10.1111/jgs.18977

Impact of inpatient geriatrics consultation on hospital outcomes in older adults with trauma

J Am Geriatr Soc. 2024 May 20. doi: 10.1111/jgs.18977. Online ahead of print.

Authors

Sara Tyree¹, Karen Fischer^{2

3}, Daniel Stephens⁴, M Caroline Burton¹, Sandeep Pagali^{1

5}

Affiliations

¹ Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
² Department of Medicine Research Hub, Mayo Clinic, Rochester, Minnesota, USA.
³ Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
⁴ Department of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Division of Geriatrics and Gerontology, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 38769752
DOI: 10.1111/jgs.18977

Abstract

Background: Older adults presenting with trauma have worse outcomes than younger adults. Starting in 2016, we provided geriatrics consultation (GC) to older adults admitted to the trauma service. We aimed to analyze the impact of GC on patient outcomes.

Methods: We performed a retrospective pre-post study and year-matched cohort study. We identified patients from the trauma registry at our level 1 trauma center. In the pre-post study, we compared patients who received GC (2016-2022) with controls (2011-2015). In the cohort study (2016-2022), we compared patients who received GC with controls. We matched for age, race, sex, and injury severity score (ISS) in both studies, as well as admission year in the cohort study. Outcome variables included mortality (in-hospital, 30-day, 90-day), length of stay (LOS), discharge disposition, and hospital readmission rates (30-day, 90-day).

Results: We analyzed 1968 patients in the pre-post study and 2544 patients in the cohort study. Patients were similar in age, race, and sex. GC patients had a slightly higher ISS score and a higher rate of ICU stay. Delirium occurrence was lower among GC patients. GC patients had lower in-hospital mortality compared to controls (pre-post OR 0.27, p < 0.001; cohort OR 0.31, p < 0.001) and increased LOS (6 days vs 4 days, p < 0.001; both studies). GC patients in the cohort study also had lower 30- and 90-day mortality (OR 0.52 and 0.65, p < 0.01) and were less likely to return home (OR 0.81, p < 0.01); similar trends, though not statistically significant, were noted in the pre-post study. Lower readmission rates (statistically non-significant) were noted in the GC group across both studies.

Conclusions: GC in older adults with trauma has proven benefit with reduced mortality and a trend toward lower readmission rates but was associated with increased LOS and higher rates of discharge to skilled facility.

Keywords: acute care; age friendly health system; geriatrics consult; length of stay; models of care; mortality.