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Text
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URL Address
<a href="http://doi.org/10.1097/TA.0000000000002155" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/TA.0000000000002155</a>
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Pages
737-743
Issue
4
Volume
86
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
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Title
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Evidence-based review of trauma center care and routine palliative care processes for geriatric trauma patients; A collaboration from the American Association for the Surgery of Trauma Patient Assessment Committee, the American Association for the Surgery of Trauma Geriatric Trauma Committee, and the Eastern Association for the Surgery of Trauma Guidelines Committee.
Publisher
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The journal of trauma and acute care surgery
Date
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2019
2019-04
Creator
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Aziz Hiba Abdel; Lunde John; Barraco Robert; Como John J; Cooper Zara; Hayward Thomas 3rd; Hwang Franchesca; Lottenberg Lawrence; Mentzer Caleb; Mosenthal Anne; Mukherjee Kaushik; Nash Joshua; Robinson Bryce; Staudenmayer Kristan; Wright Rebecca; Yon James; Crandall Marie
Description
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BACKGROUND: Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients. METHODS: A priori questions were created regarding outcomes for patients 65 years or older with respect to care at trauma centers versus nontrauma centers and use of routine palliative care processes. A query of MEDLINE, PubMed, Cochrane Library, and EMBASE was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to perform a systematic review and create recommendations. RESULTS: We reviewed seven articles relevant to trauma center care and nine articles reporting results on palliative care processes as they related to geriatric trauma patients. Given data quality and limitations, we conditionally recommend trauma center care for the severely injured geriatric trauma patients but are unable to make a recommendation on the question of routine palliative care processes for geriatric trauma patients. CONCLUSIONS: As our older adult population increases, injured geriatric patients will continue to pose challenges for care, such as comorbidities or frailty. We found that trauma center care was associated with improved outcomes for geriatric trauma patients in most studies and that utilization of early palliative care consultations was generally associated with improved secondary outcomes, such as length of stay; however, inconsistency and imprecision prevented us from making a clear recommendation for this question. As caregivers, we should ensure adequate support for trauma systems and palliative care processes in our institutions and communities and continue to support robust research to study these and other aspects of geriatric trauma. LEVEL OF EVIDENCE: Systematic review/guideline, level III.
Identifier
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<a href="http://doi.org/10.1097/TA.0000000000002155" target="_blank" rel="noreferrer noopener">10.1097/TA.0000000000002155</a>
2019
Aziz Hiba Abdel
Barraco Robert
Como John J
Cooper Zara
Crandall Marie
Department of General Surgery
Hayward Thomas 3rd
Hwang Franchesca
Lottenberg Lawrence
Lunde John
Mentzer Caleb
Mosenthal Anne
Mukherjee Kaushik
Nash Joshua
NEOMED College of Medicine
Robinson Bryce
Staudenmayer Kristan
The journal of trauma and acute care surgery
Wright Rebecca
Yon James