The Association of Time to Palliative Medicine Consultation on Geriatric Trauma Outcomes.

The integration of specialized geriatric providers with trauma services has received increased attention with promising results. Palliative medicine consultation (PMC) has been shown to reduce length of stay, improve symptom management, and clarify advance directives in the geriatric trauma population. The aim of this study was to evaluate whether PMC reduced tracheostomies and percutaneous endoscopic gastrostomies (trach/PEG) and readmission rates in the geriatric trauma population. Retrospective cohort analysis of patients 65 years of age and older, admitted to a Level I trauma center surgical intensive care unit from 2013 to 2014. Patients who died within 1 day were excluded. Statistical analyses included descriptive statistics, independent-samples t test for continuous variables, χ test for categorical variables, and logistic regression analysis. A total of 202 patients were included. Palliative medicine consultation occurred in 48%. Average time from admission to PMC was 2.91 days. Thirty-day readmission rate was 19.3%. Patients with a PMC (69.1%) were less likely to undergo trach/PEG (30.9%; p < .001) but more likely if the consult was late (>72 hr posttrauma; 22.0% vs. 40.4%; p = .05). Patients without a trach/PEG were more likely to survive 1 year posttrauma (85.7% vs. 14.3%; p = .003). Thirty-day readmission rates were similar between groups. In a logistic regression analysis, PMC, age, and injury severity score demonstrated an independent association with trach/PEG (all p < .05). Early palliative consults (<72 hr posttrauma) for geriatric trauma patients may reduce tracheostomy and percutaneous endoscopic gastrostomy procedures and hospital stays.

Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.

BACKGROUND AND OBJECTIVES: No criteria define indications for laparoscopic splenectomy in trauma. This investigation compared characteristics of trauma patients and outcomes between laparoscopic and open splenectomies. METHODS: Patients were identified retrospectively by using ICD-9 codes. Included patients were 18 or older, with a blunt splenic injury from January 1, 2011, through December 31, 2014, and required splenectomy. Excluded patients had penetrating trauma, successful nonoperative management, or successful embolization. Variables included demographics, presenting characteristics, injury severity scores, abdominal abbreviated injury scores, splenic injury grade, surgical indication and approach (open or laparoscopic), surgery length, intra-operative blood loss, transfusions, length of stay, complications, mortality, and discharge disposition. RESULTS: Forty-one patients underwent open splenectomy, and 11 underwent laparoscopic splenectomy. The mean age was 48.7 years, and men comprised the sample majority (36/52). The groups were well matched for age, abdominal injury scores, and admission vital signs. The open group had a significantly lower level of consciousness and more acidosis compared with the laparoscopic group. Most laparoscopic splenectomies were performed after failed nonoperative management or embolization. The indications for open splenectomy were a positive focused assessment with sonography for trauma and computed tomography results. Laparoscopic patients had significantly longer times between presentation and surgery and longer operations, but had significantly less blood loss and fewer transfusions compared with the open group. There were no differences in mortality, length of stay, complications, or discharge dispositions. CONCLUSION: Laparoscopic splenectomy is useful in patients with blunt trauma in whom conservative management produced no improvement and who do not have other injuries to preclude laparoscopy.

Palliative Medicine Consultation Reduces Length of Stay, Improves Symptom Management, and Clarifies Advance Directives in the Geriatric Trauma Population.

The impact of Palliative Medicine Consultation (PMC) on geriatric trauma patients' outcomes was evaluated. It was hypothesized that patients with PMC would have a shorter length of stay. Patients aged 65 years or older and admitted to trauma services were analyzed. Patients with a PMC were more likely to have a documented advance directive discussion (P < .001) and a code status update (P < .001). Length of stay was reduced for patients with a PMC on or before trauma day 2 compared to those with a PMC after trauma day 2. Palliative Medicine should be consulted early into a geriatric patient's hospital stay.

The Lack of Common Goals and Communication Within a Level I Trauma System: Assessing the Silo Effect Among Trauma Center Employees.

We assessed our level I trauma center's employees' perception of inter- and intradepartmental relationships to determine whether employees who work less often with patients feel less involved-the silo effect. We prospectively evaluated employees who provide direct patient care using the Trauma System Survey tool. Of 1155 employees, 699 responded. Combined interdepartmental relationships showed that 93% believed their unit communicated well with other units, and 86% thought other units communicated well with their unit. However, 69% experienced miscommunication between units. To reduce silos, communication is key. Training and multiunit events may help reduce these silos further.