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Background: Hip fractures in older adults are common and carry a high risk of morbidity and mortality. Preoperative dehydration, a key risk factor for adverse outcomes, is often underdiagnosed at admission. It is important to identify high risk patients and optimize modifiable risk factors to improve the postoperative outcome. The p-POSSUM Score is a useful predictor of postoperative mortality risk. Implementing a defined fluid resuscitation protocol early in high-risk groups has proven effective in reducing both postoperative morbidity and mortality. Materials and methods: We conducted a single-center, retrospective quality improvement study at a Level 1 trauma center in Switzerland, focusing on geriatric patients over 70 with a p-POSSUM Score > 5% and a proximal femur fracture, undergoing surgery between February 2015 and September 2019. We hypothesized that our institutional goal-directed fluid resuscitation protocol (GDT) would result in lower 30- and 90-day mortality rates and fewer complications for these high-risk patients. Outcome changes over time were analyzed annually. Results: 312 patients were included in our study. 147 followed our institutional GDT protocol, while 165 patients received standard care and were used as a control group. Initially, the odds ratio (OR) for 30-days mortality favored the GDT group; 2015 0.30 (CI: 0.07–1.18), 2016 0.28 (CI: 0.07–1.07), 2017 0.51 (CI: 0.13–2.04). This shifted toward the Non-GDT group in the year 2018 with a OR of 2.14 (CI: 0.59–7.84) and 2019 with 1.92 (CI 0.47–7.83). The pattern for 90-day mortality results was similar and slightly more pronounced. The estimates for the odds ratios remained consistent even after adjustment for the p-POSSUM score. The relative frequencies of complications showed no remarkable differences between the groups (GDT vs. Non-GDT). Conclusion: In our study, the treatment according to our GDT protocol was associated with survival advantage in the first three years. However, this trend reversed in 2018, with Non-GDT patients faring better. Although our retrospective study does not provide enough evidence of causality between the protocol and the mortality rates, it revealed that continuous critical evaluation of internal processes is essential in healthcare for quality management. This allows timely identification and adaptation of processes to issues, especially after initially positive results. [ABSTRACT FROM AUTHOR]

Abstract Background Hip fractures in older adults are common and carry a high risk of morbidity and mortality. Preoperative dehydration, a key risk factor for adverse outcomes, is often underdiagnosed at admission. It is important to identify high risk patients and optimize modifiable risk factors to improve the postoperative outcome. The p-POSSUM Score is a useful predictor of postoperative mortality risk. Implementing a defined fluid resuscitation protocol early in high-risk groups has proven effective in reducing both postoperative morbidity and mortality. Materials and methods We conducted a single-center, retrospective quality improvement study at a Level 1 trauma center in Switzerland, focusing on geriatric patients over 70 with a p-POSSUM Score > 5% and a proximal femur fracture, undergoing surgery between February 2015 and September 2019. We hypothesized that our institutional goal-directed fluid resuscitation protocol (GDT) would result in lower 30- and 90-day mortality rates and fewer complications for these high-risk patients. Outcome changes over time were analyzed annually. Results 312 patients were included in our study. 147 followed our institutional GDT protocol, while 165 patients received standard care and were used as a control group. Initially, the odds ratio (OR) for 30-days mortality favored the GDT group; 2015 0.30 (CI: 0.07–1.18), 2016 0.28 (CI: 0.07–1.07), 2017 0.51 (CI: 0.13–2.04). This shifted toward the Non-GDT group in the year 2018 with a OR of 2.14 (CI: 0.59–7.84) and 2019 with 1.92 (CI 0.47–7.83). The pattern for 90-day mortality results was similar and slightly more pronounced. The estimates for the odds ratios remained consistent even after adjustment for the p-POSSUM score. The relative frequencies of complications showed no remarkable differences between the groups (GDT vs. Non-GDT). Conclusion In our study, the treatment according to our GDT protocol was associated with survival advantage in the first three years. However, this trend reversed in 2018, with Non-GDT patients faring better. Although our retrospective study does not provide enough evidence of causality between the protocol and the mortality rates, it revealed that continuous critical evaluation of internal processes is essential in healthcare for quality management. This allows timely identification and adaptation of processes to issues, especially after initially positive results.

To compare outcomes between geriatric and non-geriatric patients with traumatic brain injury (TBI) transferred to trauma center and effects of anticoagulants/antiplatelets (AC/AP) and reversal therapy. A retrospective review of 1,118 patients with TBI transferred from acute care facilities to level 1 trauma center compared in groups: geriatric versus non-geriatric, geriatric with AC/AP therapy versus without, and geriatric AC/AP with AC/AP reversal therapy versus without. Patients with TBI constituted 54.4% of trauma transfers. Mean transfer time was 3.9 h. Propensity matched by Injury Severity Score and Abbreviated Injury Score (AIS) head geriatric compared to non-geriatric patients had more AC/AP use (53.9% vs 8.8%), repeat head computed tomography (93.7% vs 86.1%), intensive care unit (ICU) admissions (57.4% vs 45.7%) and mortality (9.8% vs 3.2%), all p < 0.004. Patients on AC/AP versus without had more ICU admissions (69.1% vs 51.8%, p < 0.001). Patients with AC/AP reversals compared to without reversals had more AIS head 5 (32.0% vs 13.1%), brain surgeries (17.8% vs 3.5%) and ICU admissions (84.8% vs 57.1%), all p < 0.001. TBI constituted half of trauma transfers and 10% required surgery. Based on higher ICU admissions, mortality, and prevalence of AC/AP therapy requiring reversal, geriatric patients with TBI on anticoagulants/antiplatelets should be considered for direct trauma center admission. [ABSTRACT FROM AUTHOR]

PurposeThe proportion of geriatric trauma patients (GTPs) (age ≥ 65 years old) with chest wall injury undergoing surgical stabilization of rib fractures (SSRF) nationally is unknown. We hypothesize a growing trend of GTPs undergoing SSRF, and sought to evaluate risk of respiratory complications and mortality for GTPs compared to younger adults (18-64 years old) undergoing SSRF.MethodsThe Trauma Quality Improvement Program (2010-2016) was queried for patients with rib fracture(s) who underwent SSRF. GTPs were compared to younger adults. A multivariable logistic regression analysis was performed.ResultsFrom 21,517 patients undergoing SSRF, 3,001 (16.2%) were GTPs. Of all patients undergoing SSRF in 2010, 10.6% occurred on GTPs increasing to 17.9% in 2016 (p

Geriatric trauma patients (GTP) (age ≥ 65 years) with blunt splenic injury (BSI) have up to a 6% failure rate of non-operative management (NOM). GTPs failing NOM have a similar mortality rate compared to GTPs managed successfully with NOM. However, it is unclear if this remains true in octogenarians (aged 80-89 years). We hypothesized that the failure rate for NOM in octogenarians would be similar to their younger geriatric cohort, patients aged 65-79 years; however risk of mortality in octogenarians who fail NOM would be higher than that of octogenarians managed successfully with NOM. The Trauma Quality Improvement Program (2010-2016) was queried for patients with BSI. Those undergoing splenectomy within 6 h were excluded to select for patients undergoing NOM. Patients aged 65-79 years (young GTPs) were compared to octogenarians. A multivariable logistic regression model was used to determine the risk for failed NOM and mortality. From 43,041 BSI patients undergoing NOM, 3660 (8.5%) were aged 65-79 years and 1236 (2.9%) were octogenarians. Both groups had a similar median Injury Severity Score (ISS) (p = 0.10) and failure rate of NOM (6.6% young GTPs vs. 6.8% octogenarians p = 0.82). From those failing NOM, octogenarians had similar units of blood products transfused (p > 0.05) and a higher mortality rate (40.5% vs. 18.2%, p

PurposeThe proportion of geriatric trauma patients (GTPs) (age ≥ 65 years old) with chest wall injury undergoing surgical stabilization of rib fractures (SSRF) nationally is unknown. We hypothesize a growing trend of GTPs undergoing SSRF, and sought to evaluate risk of respiratory complications and mortality for GTPs compared to younger adults (18-64 years old) undergoing SSRF.MethodsThe Trauma Quality Improvement Program (2010-2016) was queried for patients with rib fracture(s) who underwent SSRF. GTPs were compared to younger adults. A multivariable logistic regression analysis was performed.ResultsFrom 21,517 patients undergoing SSRF, 3,001 (16.2%) were GTPs. Of all patients undergoing SSRF in 2010, 10.6% occurred on GTPs increasing to 17.9% in 2016 (p

Yangfan Zhuang,1 Hao Tu,1 Quanrui Feng,2 Huiming Tang,3 Li Fu,1 Yuchang Wang,1 Xiangjun Bai1 1Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China; 2Department of Intensive Care Unit, First Hospital of Wuhan, Wuhan, Hubei Province, People’s Republic of China; 3Department of Intensive Care Unit, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, People’s Republic of ChinaCorrespondence: Xiangjun Bai, Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China, Email whtj_bxj@163.comPurpose: Currently, assessing trauma severity alone in geriatric trauma patients (GTPs) cannot accurately predict the risk of serious adverse outcomes during hospitalization. As an emerging concept in recent years, frailty syndrome is closely related to the poor prognosis of many diseases in elderly patients, including trauma. A logistic model for predicting adverse outcomes in elderly trauma patients during hospitalization was constructed in elderly patients, and the predictive efficacy of the model was verified.Patients and Methods: Trauma patients aged ≥ 65 years between June 2020 and September 2021 were selected and randomly divided into a training set and validation set at a ratio of 3:1. Mid arm muscle circumference (MAMC) was measured to determine the degree of frailty. LASSO regression was used to screen appropriate variables for the construction of a prognostic model. The logistic regression model was established and presented in the form of a nomogram. Calibration curves and ROC curves were used to verify the performance of the model.Results: A total of 209 patients were enrolled, including 143 (68.4%) males and 66 (31.6%) females, with an average age of 70.8 ± 4.8 years. Ageless Charlson comorbidity index, BT unit, ISS, GCS, MAMC, prealbumin and lactic acid levels were screened by LASSO regression to construct a prognostic model. The AUC of the ROC analysis prediction model was 0.89 (95% CI 0.80– 0.97) in the validation set. The results of the Hosmer–Lemeshow test for the validation set were χ 2 = 11.23, P = 0.189.Conclusion: The prognostic model of adverse outcomes in GTPs has good accuracy and differentiation, which can improve the prediction results of risk stratification of GTPs during hospitalization by medical staff and provide a new idea for prognostic prediction.Keywords: geriatric trauma patients, frailty, MAMC, prognostic model for adverse outcomes

Yangfan Zhuang,1 Quanrui Feng,2 Huiming Tang,3 Yuchang Wang,1 Zhanfei Li,1 Xiangjun Bai1 1Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China; 2Department of Intensive Care Unit, First Hospital of Wuhan, Wuhan, Hubei, People’s Republic of China; 3Department of Intensive Care Unit, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, People’s Republic of ChinaCorrespondence: Xiangjun Bai, Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China, Email whtj_bxj@163.comPurpose: The Geriatric Trauma Outcome Score (GTOS) has been developed and indicate to be a valid prognostic tool for the prediction of mortality in geriatric trauma patients (GTPs) during hospitalization. However, the predictive value of the GTOS for morbidity is still unclear. We aimed to evaluate the association between GTOS, morbidity and mortality in GTPs.Patients and Methods: We performed a retrospective cohort study between June 1, 2016, and May 31, 2020, and collected data for patients aged 65 years or older. These patients were treated at the Trauma Center of Tongji Hospital, Wuhan, China. Clinical data were retrieved from the trauma registry. The GTOS was calculated with the following formula: age + ISS &ast; 2.5 + 22 (if any packed red blood cells were transfused within 24 hours after admission). The outcomes were mortality, morbidity, length of hospital stay (LOS), and functional outcome at discharge.Results: A total of 485 patients were enrolled: 214 (44.1%) were classified into the low-GTOS group, and 271 (55.9%) were classified into the high-GTOS group. The median (IQR) age was 68 (66– 71) years; 361 (74.4%) were male. The most common mechanism of injury was vehicle collision (66.4%), followed by falls < 2 m (19.6%). The median (IQR) ISS was 18 (14– 22). The median (IQR) GCS was 13 (9– 15). A high GTOS was associated with high rates of all-cause mortality (13.3% vs 0.9%, P < 0.001), complications (88.2% vs 31.8%, P < 0.001), unplanned intubation (19.2% vs 1.4%, P < 0.001), and unplanned admissions to the intensive care unit (8.5% vs 0.5%, P < 0.001). In multivariable logistic regression analysis, GTOS was associated with morbidity (OR 1.07, 95% CI, 1.05– 1.09, p < 0.001) and mortality (OR 1.04, 95% CI, 1.02– 1.06, p < 0.001).Conclusion: The GTOS is an independent predictor of morbidity and mortality in GTPs, and it will help us identify patients at high risk on admission.Keywords: Geriatric Trauma Outcome Score, geriatric trauma patients, predictive value

Introduction: Reintubation in unplanned scenarios, carries inherent risks and potential complications particularly in vulnerable populations such as geriatric trauma patients. We sought to identify preadmission risk factors for unplanned re-intubation (URI) in geriatric trauma patients and its effects on outcomes., Methods: Analysis of TQIP (2017-2019) of intubated geriatric trauma patients, classified into two groups, those who were successfully extubated and those who required URI. We used logistic regression to assess for preadmission risk factors of URI., Results: Among 23,572 patients, 20.2 ​% underwent URI. URI had higher mortality (13.7%vs.8.1 ​%, p ​< ​0.001), in-hospital complications (p ​< ​0.05), longer hospital and ICU LOS (p ​< ​0.001 for both). Higher age (OR ​= ​1.017), smoking (OR ​= ​1.418), CRF(OR ​= ​1.414), COPD (OR ​= ​1.410), alcohol use (OR ​= ​1.365), functionally dependent health status (OR ​= ​1.339), and anticoagulant use (OR ​= ​1.148), increased the risks of URI (p ​< ​0.05 for all)., Conclusion: Geriatric patients with comorbidities including age, smoking, CRF, COPD, alcohol use, dependent status, and anticoagulant use are at higher risks of URI that could in turn, be associated with increased rates of mortality, complications, and longer hospital and ICU length of stay., Level of Evidence: Level III retrospective study., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Pelvic fractures (PF) with concomitant injuries are on the rise due to an increase of high-energy trauma. Increase of the elderly population with age related comorbidities further complicates the management. Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones. Presence of contrast blush (CB) on computed tomography in patients with PF is considered a sign of active bleeding, however, its clinical significance and association with outcomes is debatable., Aim: To analyze polytrauma patients with PF with a focus on the geriatric population, co-injuries and the value of contrast blush., Methods: This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center (01/2017-01/2023). Analyzed variables included: Age, sex, mechanism of injury (MOI), injury severity score (ISS), Glasgow coma scale (GCS), abbreviated injury scale (AIS), co-injuries, transfusion requirements, pelvic angiography, embolization , laparotomy, orthopedic pelvic surgery, intensive care unit and hospital lengths of stay, discharge disposition and mortality. The study compared geriatric and non-geriatric patients, patients with and without CB and abdominal co-injuries. Propensity score matching was implemented in comparison groups., Results: PF comprised 4% of all trauma admissions. 89 patients had CB. 286 (52%) patients had concomitant injuries including 93 (17%) patients with abdominal co-injuries. Geriatric patients compared to non-geriatric had more falls as MOI, lower ISS and AIS pelvis, higher GCS, less abdominal co-injuries, similar CB and angio-embolization rates , less orthopedic pelvic surgeries, shorter lengths of stay and higher mortality. After propensity matching , orthopedic pelvic surgery rates remained lower (8% vs 19%, P < 0.001) , hospital length of stay shorter, and mortality higher (13% vs 4%, P < 0.001) in geriatric patients. Out of 89 patients with CB, 45 (51%) were embolized. After propensity matching , patients with CB compared to without CB had more pelvic angiography (71% vs 12%, P < 0.001), higher embolization rates (64% vs 22%, P = 0.02) and comparable mortality., Conclusion: Half of the patients with PF had concomitant co-injuries, including abdominal co-injuries in 17%. Similarly injured geriatric patients had higher mortality. Half of the patients with CB required an embolization., Competing Interests: Conflict-of-interest statement: Alexander A Fokin, Joanna Wycech Knight, Madison Tharp, Kyler Brinton, Phoebe K Gallagher, Justin F Xie, Russell D Weisz and Ivan Puente declare that they have no conflict of interest. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

To examine the relationship between the number of rib fractures (RIBFs) and mortality, injury severity, and resource consumption in elderly patients admitted to trauma centers. Thirteen-year retrospective statewide database analysis. Participating trauma centers in Pennsylvania. A total of 27,855 trauma patients, including 8,648 elderly patients, admitted to a trauma center with more than one RIBF. Patient demographics, number of RIBFs, Injury Severity Score, complications, patient mortality, preexisting conditions (PECs), and hospital and intensive care unit length of stay. Mortality for elderly patients (aged≥65) with RIBFs was greater than for patients younger than 65 (20.1% vs 11.4%, P<.001). Mortality rates increased with increasing numbers of RIBFs for both age groups and were always significantly higher in elderly trauma patients. The effect of PECs on patient mortality was inversely related to number of RIBFs and was most pronounced for patients with four or more RIBFs. Seven of 10 complications were more common in elderly patients despite lower mean±standard deviation Injury Severity Score (19.4±13.4 vs 23.2±14.2, P<.001). Overall trauma-related mortality is higher in elderly patients with RIBFs than younger patients with RIBFs. Mortality rates rise with increasing number of RIBFs. The number of RIBFs is easy to quantify and may be a useful predictor of overall injury severity and outcome for elderly trauma patients. [ABSTRACT FROM AUTHOR]