title: High-risk geriatric protocol: improving mortality in the elderly.
abstract: BACKGROUND
  Injured geriatric patients pose unique challenges to the trauma team because of their abnormal responses to shock and injury. We have developed the high-risk geriatric protocol (GP) that seeks to identify high-risk geriatric patients. We hypothesized that a high-risk GP would improve outcome in this select group of patients.
  
  
  METHODS
  Patients from 2000 to 2010 were included. Patients 65 years or older who met high-risk GP based on comorbidities and/or physiologic parameters were compared with those patients who had not received GP before its implementation as well as other non-GP patients. This protocol includes a geriatric consultation, as well as a lactate levels, arterial blood gas levels, and echo test to assess for occult shock. Age, trauma activation, preexisting conditions, Injury Severity Score, Revised Trauma Score, and mortality were reviewed. Univariate and multivariate analyses were conducted to identify factors predictive of mortality.
  
  
  RESULTS
  A total of 3,902 patients were evaluated. Patients receiving GP were less likely to die (odds ratio, 0.63 [0.39-0.99], p = 0.046). For all patients, there was a dramatic increase in mortality for those patients older than 75 years.
  
  
  CONCLUSIONS
  The GP, adjusted for other covariates, significantly reduced mortality in our patient population. Thus, this study confirms the overall effectiveness of our GP, which is hallmarked by prompt identification of those patients with occult shock and a multidisciplinary care of the aged population.
authors: Department of Trauma, Critical Care and Acute Care Surgery, Lancaster General Hospital, Lancaster, Pennsylvania 17602, USA.
authors: Eric
authors: E
authors: Bradburn
authors: Frederick B
authors: FB
authors: Rogers
authors: Margaret
authors: M
authors: Krasne
authors: Amelia
authors: A
authors: Rogers
authors: Michael A
authors: MA
authors: Horst
authors: Matthew J
authors: MJ
authors: Beelen
authors: Matthew J
authors: MJ
authors: Belan
authors: Jo Ann
authors: JA
authors: Miller
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration*; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D016019:Survival Analysis; D014193:Trauma Centers; D016896:Treatment Outcome; D014218:Triage; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*