title: Geriatric outcomes are improved by a geriatric trauma consultation service.
abstract: BACKGROUND
  Traumatic injuries in older patients are complex and have significant impact on the individual, their family, and trauma centers. We hypothesized that greater attention to the timely identification and comprehensive management of comorbid conditions would improve outcomes in the care of the older injured patient.
  
  
  METHODS
  This was a prospective, descriptive study of all patients 65 years of age and older admitted to the trauma service. Each elder was seen by a specialist in geriatrics ideally within 24 hours of admission to the trauma service. A standardized consult was developed for the electronic medical record and utilized in every case. Data were obtained from the trauma registry to characterize the nature of injury, injury severity, and outcome. Data from the geriatric consult were compiled to determine the impact of age- associated conditions on the outcome.
  
  
  RESULTS
  There were 285 injured patients, aged 65 years and older. Of these, 114 were seen in consultation. Age range was 65 to 96 years, with an average of 77.7 years. Injury Severity Score range was 3 to 75, with an average of 9.3. There were an equal number of male and female patients. Falls and motor vehicle collisions predominated. Geriatricians identified the following: 14% of patients presented with alcohol issues; 36% of patients exhibited signs of delirium; and 46% of patients presented with new medical conditions. Geriatricians assisted with advanced care planning in 15% of cases; disposition decisions to promote function in 49%; made medication changes in 65%; decreased inappropriate medications in 20%; and assisted with pain management in 42%. Trauma surgeons followed one or more recommendations in 91%.
  
  
  CONCLUSIONS
  Outcomes of older patients can be improved through geriatricians' expertise by addressing new and existing medical issues and reducing hospital-acquired complications such as functional decline, falls, delirium, and death.
authors.affiliation: Department of Surgery, Summa Health System, Akron City Hospital, Akron, Ohio 44309, USA. fallonw@summa-health.org
authors.forename: William F
authors.initials: WF
authors.lastname: Fallon
authors.forename: Erin
authors.initials: E
authors.lastname: Rader
authors.forename: Stephen
authors.initials: S
authors.lastname: Zyzanski
authors.forename: Charlene
authors.initials: C
authors.lastname: Mancuso
authors.forename: Berni
authors.initials: B
authors.lastname: Martin
authors.forename: Linda
authors.initials: L
authors.lastname: Breedlove
authors.forename: Peter
authors.initials: P
authors.lastname: DeGolia
authors.forename: Kyle
authors.initials: K
authors.lastname: Allen
authors.forename: James
authors.initials: J
authors.lastname: Campbell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005853:Geriatrics / Q000458:organization & administration*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011446:Prospective Studies; D012017:Referral and Consultation; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014194:Traumatology / Q000458:organization & administration*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*