Geriatric Trauma Intensive Care Unit Admission Guideline Is Associated With Reduction in Unplanned Intensive Care...

Area of Science:

• Trauma Surgery
• Geriatric Medicine
• Intensive Care Medicine
• Health Services Research

Background:

• Geriatric trauma patients face worse outcomes than younger counterparts with similar injuries.
• A Geriatric Trauma Intensive Care Unit (ICU) Admission Guideline was developed to enhance early care for high-risk elderly patients.
• The guideline aimed to reduce unplanned ICU admissions (UIAs), a key indicator of adverse outcomes.

Purpose of the Study:

• To evaluate the impact of implementing a Geriatric Trauma ICU Admission Guideline on UIAs in elderly trauma patients.
• To assess secondary outcomes including mortality, length of stay, and readmissions following guideline implementation.

Main Methods:

• A retrospective analysis of trauma registry data was conducted at a level-1 trauma center.
• Geriatric patients meeting ICU admission criteria were compared pre- and post-guideline implementation (July 1, 2020).
• Statistical analyses included t-tests, Mann-Whitney U, chi-square, and risk-adjusted regressions to compare outcomes.

Main Results:

• The post-implementation group showed a higher incidence of ≥3 rib fractures and increased initial ICU level of care.
• Implementation of the guideline was associated with a 50% reduction in UIAs (adjusted odds ratio 0.52).
• No significant differences were observed in mortality, 30-day readmissions, or various free-day metrics.

Conclusions:

• The Geriatric Trauma ICU Admission Guideline effectively reduced UIAs by half in the target geriatric trauma population.
• The guideline did not significantly alter mortality, readmission rates, or patient-free days.
• Further research is recommended to refine guidelines, assess delirium impact, and establish criteria for safe downgrading.