Abstract
BackgroundThe demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced Trauma Life Support (ATLS) and imply early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management.MethodsSingle-centre cohort study. We included all patients ≥65 years of age with an Injury Severity Score (ISS) ≥ 9 who were admitted to our hospital primarily via ER. A historic cohort was compared to a cohort after the implementation of the new SOPs.ResultsWe enrolled 311 patients who met the inclusion criteria between 2000 and 2006 (group PreSOP) and 2010–2012 (group SOP). There was a significant reduction in the mortality rate after the implementation of the new SOPs (P = .001). This benefit was seen only for severely injured patients (ISS ≥ 16), but not for moderately injured patients (ISS 9–15). There were no differences with regard to infection rates or rate of palliative care.ConclusionsWe found an association between implementation of new ER SOPs, and a lower mortality rate in severely injured geriatric trauma patients, whereas moderately injured patients did not obtain the same benefit.Trial registrationClinicaltrials.gov NCT03319381, retrospectively registered 24 October 2017.
Highlights
The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures
We aimed to address the need for standardisation of definitions and evaluating the prognostic value of injury severity scores in improving outcomes in geriatric trauma patients
We investigated whether there were changes in the in-hospital mortality, infection rate, and rate of palliative care after the implementation of new standard operating procedures (SOPs) comprising early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management based on an Advanced Trauma Life Support (ATLS)-based algorithm
Summary
The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. Several studies have demonstrated that geriatric trauma patients have worse outcomes if the severity of the injury is equivalent [6,7,8,9,10]. These poor outcomes are linked to a higher susceptibility to post-traumatic infections, decreased physiological reserves, and pre-existing diseases in elderly trauma patients [11, 12]. This concept of frailty has only recently been recognized in surgical practice [13].
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