Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review. Issue 2 (21st February 2023)

• Record Type: Journal Article
• Authors: Halter, Mary; Jarman, Heather; Moss, Phil; Kulnik, Stefan Tino; Baramova, Desislava; Gavalova, Lucia; Cole, Elaine; Crouch, Robert; Baxter, Mark
• Is Part Of: BMJ open. Volume 13:Issue 2(2023)
• Publication Date: 2023-02-21
• Subjects: accident & emergency medicine -- geriatric medicine -- trauma management; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2022-066329
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To systematically review research on acute hospital care for frail or older adults experiencing moderate to major trauma. Setting: Electronic databases (Medline, Embase, ASSIA, CINAHL Plus, SCOPUS, PsycINFO, EconLit, The Cochrane Library) were searched using index and key words, and reference lists and related articles hand-searched. Included articles: Peer-reviewed articles of any study design, published in English, 1999–2020 inclusive, referring to models of care for frail and/or older people in the acute hospital phase of care following traumatic injury defined as either moderate or major (mean or median Injury Severity Score ≥9). Excluded articles reported no empirical findings, were abstracts or literature reviews, or referred to frailty screening alone. Methods: Screening abstracts and full text, and completing data extractions and quality assessments using QualSyst was a blinded parallel process. A narrative synthesis, grouped by intervention type, was undertaken. Outcome measures: Any outcomes reported for patients, staff or care system. Results: 17 603 references were identified and 518 read in full; 22 were included—frailty and major trauma (n=0), frailty and moderate trauma (n=1), older people and major trauma (n=8), moderate or major trauma (n=7) 0r moderate trauma (n=6) . Studies were observational, heterogeneous in intervention and with variable methodological quality. Specific attention given to the care of older and/or frail people with moderate to major trauma in the North American context resulted in improvements to in-hospital processes and clinical outcomes, but highlights a relative paucity of evidence, particularly in relation to the first 48 hours post-injury. Conclusions: This systematic review supports the need for, and further research into an intervention to address the care of frail and/or older patients with major trauma, and for the careful definition of age and frailty in relation to moderate or major trauma. International Prospective Register of Systematic Reviews (PROSPERO): CRD42016032895.