CORONADO, CALIF. – When elderly patients are appropriately triaged, they can be selectively admitted to non–intensive care wards with acceptable outcomes, results from a single-center study showed.
“Trauma centers across the United States are caring for elderly trauma patients with greater frequency,” researchers led by Marc D. Trust, MD, wrote in an abstract presented during a poster session at the annual meeting of the Western Surgical Association.
“Previous literature showed improved outcomes in this population from aggressive care and invasive monitoring. This may have led to an increased utilization of intensive care resources for these patients,” they noted.
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In an effort to assess the safety of admitting this population of patients to non–intensive care units, Dr. Trust, a surgery resident at the University of Texas at Austin, and his associates retrospectively reviewed the medical records of 3,682 trauma patients aged 65 and older who were admitted from 2006 to 2015. They compared demographic data and outcomes between patients admitted to the ICU and those admitted to the surgical ward. The primary endpoint was mortality, while secondary endpoints were transfer to higher level of care and hospital length of stay. Patients admitted only for comfort care and those with injuries thought to be terminal and irreversible were excluded from the analysis.
The mean age of the 3,682 patients was 76 years and 1,838 (50%) were admitted to the ICU, while the remaining 1,844 (50%) were admitted to the surgical ward. When the researchers compared patients admitted to the ICU with those admitted to the surgical ward, they observed significant differences in mortality (7% vs. 0.82%, respectively; P less than .001), as well as systolic blood pressure on admission (146 vs. 149 mm Hg, respectively; P = .0002), pulse (85 vs. 81 beats per minute; P less than .0001), Glasgow Coma Scale (14 vs. 15; P less than .001), Injury Severity Score (16 vs. 8; P less than .001), and hospital stay (a mean of 8 vs. 4 days; P less than .0001). In addition, fewer than 1% of patients admitted to the surgical ward required transfer to a higher level of care (P less than .0001).
Next, Dr. Trust and his associates conducted a subgroup analysis of 300 patients admitted to the ICU (28%) and 766 (72%) admitted to the surgical ward who had all-system Abbreviated Injury Scale scores of less than 3, no hypotension on admission, and a Glasgow Coma Scale of 14 or greater. Compared with those admitted to the surgical ward, those admitted to the ICU were older (77 vs. 76 years old, respectively; P = .003), more likely to be male (54% vs. 45%; P = .007), more tachycardic (HR 84 vs. 81; P = .004), more severely injured (ISS score of 5 vs. 4; P less than .0001), and more likely to have a longer hospital stay (a mean of 6 vs. 4 days; P less than .0001). Two patients admitted to the surgical ward died (0.26%; P = .0009) and none required transfer to a higher level of care.
The researchers reported having no financial disclosures.