Geriatric Trauma Service

Original Date: 10/2020 | Last Review Date: 01/2023
Purpose: To optimize management of comorbidities in our geriatric trauma population.

Background

Traumatic injury in the geriatric population is increasing in prevalence and is associated with higher morbidity and mortality compared with younger patients. Optimization of medical comorbidities and a multidisciplinary approach to minimize complications, such as medication-related adverse side effects and delirium, have been associated with improved outcomes.

The Division of Acute Care Surgery Geriatric Trauma Task Force is a multi-disciplinary team created to improve geriatric trauma care based on TQIP performance in the elderly patient cohorts. Based on recommendations from this group, best available evidence, and input from the UTHealth Consortium on Aging, we will form the Geriatric Trauma Service (GTS) with the following goals:

  • standardize care for geriatric patients through a multi-disciplinary team
  • optimize pre-existing medical comorbidities in the traumatically injured patient
  • minimize complications with delirium prevention, diagnosis and treatment of occult hypoperfusion, and avoidance of medication-related adverse side effects with use of geriatric-specific clinical care bundles and admission MPPs
  • improve clinical outcomes in our geriatric trauma population

The geriatric trauma service will be staffed by members of the Division of Acute Care Surgery with board certification in Internal Medicine with additional training in geriatric and trauma care. They will maintain 12 hours of trauma-specific CME annually and have ATLS certification. We will continue multi-disciplinary educational conferences between services including but not limited to trauma surgeons, hospitalist physicians, emergency medicine physicians, geriatricians, orthopedic surgeons, and pharmacists.

Any patient with surgical incisions, drains, or tubes placed by the trauma service will be co-managed with assistance of the rounding trauma chief or faculty and stay on the REDCap trauma list under GTS. The GTS faculty will also attend trauma educational conferences, including M&M, trauma-multi-disciplinary meeting, and trauma-specific Grand Rounds.

Procedure

Geriatric Trauma Service (GTS) Admission Criteria

Patients ≥ 65 years old may be admitted to the GTS after evaluation by trauma faculty.

GTS will NOT admit the following patients:

  • ICU level of care
  • Traumatic Brain Injury on CT scan
  • any emergent procedure (IR or OR) from ED
  • patients that received a blood transfusion

Admission from the Emergency Department (ED)

The trauma team will be consulted based on existing criteria within the Trauma Team Consultation Policy (insert hyperlink). If deemed appropriate for admission to the Geriatric Trauma Service following evaluation by trauma faculty, the ED faculty will consult the GTS faculty via PerfectServe for consultation and admission. Any clinical questions or concerns regarding GTS admission will be discussed between the GTS and trauma faculty.

Patients with traumatic mechanism of injury and age ≥65 currently admitted to the hospitalist service also qualify for admission to the Geriatric Trauma Service.

Patients meeting GTS admission criteria with traumatic injuries managed by the trauma service (rib fractures, low grade solid organ injuries, open wounds, etc) will be admitted to the GTS and co-managed by trauma surgeons. Please add these patients to the REDCap trauma list and select “GTS” under the unit drop down list under location. These patients will be primarily managed by GTS and evaluated by the trauma service daily.

Transfer of care to GTS

STICU patients meeting the above admission criteria to GTS may be transferred to GTS once they no longer require ICU level of care. This transfer of care will be at the discretion of the STICU attending and a physician-to-physician phone call will take place prior to transfer.

References

American College of Surgeons Trauma Quality Improvement Program. ACS TQIP Geriatric Trauma Management Guidelines. October 2013. https://www.facs.org/quality-programs/trauma/tqp/center-programs/tqip/best-practice.

Hatton GE, McNutt MK, Cotton BA, Hudson JA, Wade CE, Kao LS. Age-Dependent Association of Occult Hypo perfusion and Outcomes in Trauma. J Am Coll Surg 2020 Apr; 230(4): 417-425. PMID: 31954820.

Mangram AJ, Mitchell CD, Shifflette VK, Lorenzo M, Truitt MS, Goel A, Lyons MA, Nichols DJ, Dunn EL. Geriatric trauma service: A one-year experience. J Trauma Acute Care Surg. January 2012;72(1): 119-122.

Lenartowics M, Parkovnick M, McFarlan A, Haas B, Straus SW, Nathens AB, Wong CL. An evaluation of a proactive geriatric trauma consultation service. Ann Surg. December 2012; 256(6): 1098-101.