Comparison of Geriatric Versus Non-geriatric Trauma Patients

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Comparison of Geriatric Versus Non-geriatric Trauma Patients With Palliative Care Consultations ,
Joanna Wycech, MS,a , c Alexander A Fokin, MDPhD,a , b ,
Jeffrey K. Katz, MD,a , b Sari Viitaniemi, RNMSN,a Nicholas Menzione, MD,a
and Ivan Puente, MDFACS,a , b , c , d
a Division of Trauma and Critical Care Services, Delray Medical Center, Delray Beach, Florida b Department of Surgery, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida c Division of Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, Florida d Department of Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
a r t i c l e i n f o
Article history:
Received 8 October 2020
Revised 22 January 2021
Accepted 27 February 2021
Geriatric trauma
Palliative care
Palliative care consultations
Do-Not-Resuscitate orders
Futile interventions
Propensity matched comparison
a b s t r a c t
Background: Palliative care in trauma patients is still evolving. The goal was to compare char-
acteristics, outcomes, triggers and timing for palliative care consultations (PCC) in geriatric
( 65 y.o.) and non-geriatric trauma patients . Materials and methods: Retrospective study included 432 patients from two level 1 trauma
centers who received PCC between December 2012 and January 2019. Non-geriatric ( n = 61) and geriatric ( n = 371) groups were compared for: mechanism of injury (MOI), Injury Sever- ity Score (ISS), Revised Trauma Score (RTS), Glasgow Coma Score (GCS), Do-Not-Resuscitate
(DNR) orders, futile interventions (FI), duration of mechanical ventilation (DMV), ICU admis-
sions, ICU and hospital lengths of stay (ICULOS; HLOS), timing to PCC, and mortality. Fur-
ther propensity matching (PM) analysis compared 59 non-geriatric to 59 Geriatric patients
matched by ISS, GCS, and DNR.
Results: Geriatric patients were older (85.2 versus 49.7), with falls as predominant MOI. Non-
geriatric patients comprised 14.1% of all patients with PCC and were more severely injured
than Geriatrics: with statistically higher ISS (24.1 versus 18.5), lower RTS (5.4 versus 7.0), GCS
(7.1 versus 11.5), with predominant MOI being traffic accidents, all P < 0.01. Non-Geriatrics
had more ICU admissions (96.7% versus 88.1%), longer ICULOS (10.2 versus 4.7 days), DMV
(11.1 versus 4.1 days), less DNR (57.4% versus 73.9%), higher in-hospital mortality (12.5% versus
2.6%), but double the time admission-PCC (11.3 versus 4.3 days) compared to Geriatrics, all
This is an IRB approved study. This manuscript is not under consideration elsewhere, has not been published previously and will not appear online or in print in any media until a decision is made concerning publication in the Journal of Surgical Research.
Corresponding author. Delray Medical Center, Division of Trauma and Critical Care Services 5352 Linton Boulevard Delray Beach, FL 33484.
E-mail address:[email protected](A.A. Fokin). 0022-4804/ 2021 Elsevier Inc. All rights reserved.

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