A national study of 23 major trauma centres to investigate the effect of a geriatrician assessment on clinical outcomes in older people admitted with serious injury in England (FiTR 2): a multicentre observational cohort study.

Aged Aged, 80 and over Cohort Studies England / epidemiology Female Geriatricians Hospitalization Humans Male Trauma Centers

Journal

The lancet. Healthy longevity
ISSN: 2666-7568
Titre abrégé: Lancet Healthy Longev
Pays: England
ID NLM: 101773309

Informations de publication

Date de publication:
08 2022
Historique:
received: 08 03 2022
revised: 19 05 2022
accepted: 20 05 2022
entrez: 14 9 2022
pubmed: 15 9 2022
medline: 17 9 2022
Statut: ppublish

Résumé

Older people are at the greatest risk of poor outcomes after serious injury. Evidence is limited for the benefit of assessment by a geriatrician in trauma care. We aimed to determine the effect of geriatrician assessment on clinical outcomes for older people admitted to hospital with serious injury. In this multicentre observational study (FiTR 2), we extracted prospectively collected data on older people (aged ≥65 years) admitted to the 23 major trauma centres in England over a 2·5 year period from the Trauma Audit and Research Network (TARN) database. We examined the effect of a geriatrician assessment within 72 h of admission on the primary outcome of inpatient mortality in older people admitted to hospital with serious injury, with patients censored at discharge. We analysed data using a multi-level Cox regression model and estimated adjusted hazard ratios (aHRs). Between March 31, 2019, and Oct 31, 2021, 193 156 patients had records held by TARN, of whom 35 490 were included in these analyses. Median age was 81·4 years (IQR 74·1-87·6), 19 468 (54·9%) were female, and 16 022 (45·1%) were male. 28 208 (79·5%) patients had experienced a fall from less than 2 m. 16 504 (46·5%) people received a geriatrician assessment. 4419 (12·5%) patients died during hospital stay, with a median time from admission to death of 6 days (IQR 2-14). Of those who died, 1660 (37·6%) had received a geriatrician assessment and 2759 (62·4%) had not (aHR 0·43 [95% CI 0·40-0·46]; p<0·0001). Geriatrician assessment was associated with a reduced risk of death for seriously injured older people. These data support routine provision of geriatrician assessment in trauma care. Future research should explore the key components of a geriatrician assessment paired with a health economic evaluation. None.

Sections du résumé

BACKGROUND
Older people are at the greatest risk of poor outcomes after serious injury. Evidence is limited for the benefit of assessment by a geriatrician in trauma care. We aimed to determine the effect of geriatrician assessment on clinical outcomes for older people admitted to hospital with serious injury.
METHODS
In this multicentre observational study (FiTR 2), we extracted prospectively collected data on older people (aged ≥65 years) admitted to the 23 major trauma centres in England over a 2·5 year period from the Trauma Audit and Research Network (TARN) database. We examined the effect of a geriatrician assessment within 72 h of admission on the primary outcome of inpatient mortality in older people admitted to hospital with serious injury, with patients censored at discharge. We analysed data using a multi-level Cox regression model and estimated adjusted hazard ratios (aHRs).
FINDINGS
Between March 31, 2019, and Oct 31, 2021, 193 156 patients had records held by TARN, of whom 35 490 were included in these analyses. Median age was 81·4 years (IQR 74·1-87·6), 19 468 (54·9%) were female, and 16 022 (45·1%) were male. 28 208 (79·5%) patients had experienced a fall from less than 2 m. 16 504 (46·5%) people received a geriatrician assessment. 4419 (12·5%) patients died during hospital stay, with a median time from admission to death of 6 days (IQR 2-14). Of those who died, 1660 (37·6%) had received a geriatrician assessment and 2759 (62·4%) had not (aHR 0·43 [95% CI 0·40-0·46]; p<0·0001).
INTERPRETATION
Geriatrician assessment was associated with a reduced risk of death for seriously injured older people. These data support routine provision of geriatrician assessment in trauma care. Future research should explore the key components of a geriatrician assessment paired with a health economic evaluation.
FUNDING
None.

Identifiants

DOI: 10.1016/S2666-7568(22)00144-1 PMID: 36102764
pubmed: 36102764
pii: S2666-7568(22)00144-1
doi: 10.1016/S2666-7568(22)00144-1
pii:
doi:

Types de publication

Journal Article Multicenter Study Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e549-e557

Subventions

Organisme : Department of Health
Pays : United Kingdom

Commentaires et corrections

Type : CommentIn
Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests FL receives renumeration as a research director for TARN, which is funded through member NHS hospitals and hospitals in Ireland by recurrent annual subscription. DS has received reimbursement for expert testimony in matters relation to geriatric trauma for the UK courts from UK National Health Service resolution, HM coroner, and instructing litigant or defendant parties. All other authors declare no competing interests.

Auteurs

Philip Braude (P)

CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK. Electronic address: philip.braude@nbt.nhs.uk.

Roxanna Short (R)

CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Omar Bouamra (O)

The Trauma Audit and Research Network, The University of Manchester, Salford Royal - Northern Care Alliance NHS Foundation Trust, Salford, UK.

David Shipway (D)

CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Population Health Science Institute, University of Bristol, Bristol, UK.

Fiona Lecky (F)

The Trauma Audit and Research Network, The University of Manchester, Salford Royal - Northern Care Alliance NHS Foundation Trust, Salford, UK; Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK; Emergency Department, Salford Royal Hospital, Salford, UK.

Edward Carlton (E)

Translational Health Science Institute, Bristol Medical School, University of Bristol, Bristol, UK; Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK.

Jonathan Benger (J)

Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK.

Adam Gordon (A)

Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Derby Medical School, Royal Derby Hospital, Derby, UK; NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK.

Ben Carter (B)

CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › A national study of 23 major trauma centres to...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › A national study of 23 major trauma centres to...
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