A systematic review and meta-analysis evaluating geriatric consultation on older trauma patients. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Eagles, Debra; Godwin, Bradley; Cheng, Wei; Moors, Joy; Figueira, Sonshire; Khoury, Lara; Fournier, Karine; Lampron, Jacinthe
• Is Part Of: Journal of trauma and acute care surgery. Volume 88:Issue 3(2020)
• Publication Date: 2020-03
• Subjects: Geriatric -- trauma -- meta-analysis -- systematic review; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000002571
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : BACKGROUND: Early involvement of geriatrics is recommended for older trauma patients. OBJECTIVE: This systematic review aimed to determine the impact of a geriatric assessment on mortality, hospital length of stay, discharge destination, and delirium incidence in patients 65 years and older admitted to a trauma center. METHODS: The protocol was developed according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and registered in PROSPERO (CRD42019131870). Search of five databases was completed April 2019. Two independent reviewers completed screening, full text review, and data abstraction. Meta-analysis was performed on outcomes with at least two studies. RESULTS: A total of 928 unique citations were identified; eight were included in the final analysis. All were cohort studies, most of moderate to poor quality using the Newcastle-Ottawa Scale. We found hospital length of stay decreased by mean of 1.11 days (95% confidence interval, 0.79–1.43), but mortality was unchanged (odds ratio, 1.01; 95% confidence interval, 0.74–1.38) in older patients admitted to a trauma center who had a geriatric consultation. Meta-analysis of discharge destination and delirium incidence was not performed due to heterogeneity. CONCLUSIONS: This is the first systematic review and meta-analysis to evaluate outcomes in older patients admitted to a trauma center after implementation of a geriatric trauma consultation service. We found a decrease in hospital length of stay but insufficient evidence of change in in-hospital mortality in older patients who received a geriatric consultation as part of their trauma care compared with those that received standard trauma care only. There is a need for more methodologically rigorous research in geriatric trauma. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level III. Abstract : Supplemental digital content is available in the text.