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Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single

Lorenz Peterer¹, Christian Ossendorf¹, Kai Oliver Jensen¹

¹Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

|December 21, 2019

Abstract

Background:

The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced Trauma Life Support (ATLS) and imply early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management.

Methods:

Single-centre cohort study. We included all patients ≥65 years of age with an Injury Severity Score (ISS) ≥ 9 who were admitted to our hospital primarily via ER. A historic cohort was compared to a cohort after the implementation of the new SOPs.

Results:

We enrolled 311 patients who met the inclusion criteria between 2000 and 2006 (group PreSOP) and 2010-2012 (group SOP). There was a significant reduction in the mortality rate after the implementation of the new SOPs (P = .001). This benefit was seen only for severely injured patients (ISS ≥ 16), but not for moderately injured patients (ISS 9-15). There were no differences with regard to infection rates or rate of palliative care.

Conclusions:

We found an association between implementation of new ER SOPs, and a lower mortality rate in severely injured geriatric trauma patients, whereas moderately injured patients did not obtain the same benefit.

Trial Registration:

Clinicaltrials.gov NCT03319381, retrospectively registered 24 October 2017.

Keywords:

Algorithm Geriatrics In-hospital mortality Multiple trauma Standard of care

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