Are geriatric transfer patients with traumatic brain injury at risk for worse outcomes compared to non-geriatric? Propensity-matched study.

OBJECTIVE: To compare outcomes between geriatric and non-geriatric patients with traumatic brain injury (TBI) transferred to trauma center and effects of anticoagulants/antiplatelets (AC/AP) and reversal therapy. METHODS: A retrospective review of 1,118 patients with TBI transferred from acute care facilities to level 1 trauma center compared in groups: geriatric versus non-geriatric, geriatric with AC/AP therapy versus without, and geriatric AC/AP with AC/AP reversal therapy versus without. RESULTS: Patients with TBI constituted 54.4% of trauma transfers. Mean transfer time was 3.9 h. Propensity matched by Injury Severity Score and Abbreviated Injury Score (AIS) head geriatric compared to non-geriatric patients had more AC/AP use (53.9% vs 8.8%), repeat head computed tomography (93.7% vs 86.1%), intensive care unit (ICU) admissions (57.4% vs 45.7%) and mortality (9.8% vs 3.2%), all p < 0.004. Patients on AC/AP versus without had more ICU admissions (69.1% vs 51.8%, p < 0.001). Patients with AC/AP reversals compared to without reversals had more AIS head 5 (32.0% vs 13.1%), brain surgeries (17.8% vs 3.5%) and ICU admissions (84.8% vs 57.1%), all p < 0.001. CONCLUSION: TBI constituted half of trauma transfers and 10% required surgery. Based on higher ICU admissions, mortality, and prevalence of AC/AP therapy requiring reversal, geriatric patients with TBI on anticoagulants/antiplatelets should be considered for direct trauma center admission.

Comparison of Geriatric Versus Non-geriatric Trauma Patients With Palliative Care Consultations.

BACKGROUND: Palliative care in trauma patients is still evolving. The goal was to compare characteristics, outcomes, triggers and timing for palliative care consultations (PCC) in geriatric (≥65 y.o.) and non-geriatric trauma patients. MATERIALS AND METHODS: Retrospective study included 432 patients from two level 1 trauma centers who received PCC between December 2012 and January 2019. Non-geriatric (n = 61) and geriatric (n = 371) groups were compared for: mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Glasgow Coma Score (GCS), Do-Not-Resuscitate (DNR) orders, futile interventions (FI), duration of mechanical ventilation (DMV), ICU admissions, ICU and hospital lengths of stay (ICULOS; HLOS), timing to PCC, and mortality. Further propensity matching (PM) analysis compared 59 non-geriatric to 59 Geriatric patients matched by ISS, GCS, and DNR. RESULTS: Geriatric patients were older (85.2 versus 49.7), with falls as predominant MOI. Non-geriatric patients comprised 14.1% of all patients with PCC and were more severely injured than Geriatrics: with statistically higher ISS (24.1 versus 18.5), lower RTS (5.4 versus 7.0), GCS (7.1 versus 11.5), with predominant MOI being traffic accidents, all P < 0.01. Non-Geriatrics had more ICU admissions (96.7% versus 88.1%), longer ICULOS (10.2 versus 4.7 days), DMV (11.1 versus 4.1 days), less DNR (57.4% versus 73.9%), higher in-hospital mortality (12.5% versus 2.6%), but double the time admission-PCC (11.3 versus 4.3 days) compared to Geriatrics, all P < 0.04. In PM comparison, despite same injury severity, Non-geriatrics had triple the time to PCC, five times the HLOS of geriatrics, and more FI (25.4% versus 3.4%), all P < 0.001. CONCLUSIONS: PCC remains underutilized in non-geriatric trauma patients. Despite higher injury severity, non-geriatrics received more aggressive treatment, and had three times longer time to PCC, resulting in higher rate of FI than in Geriatrics.

Comparing Opinions on Meaningful Recognition: Do Views of Trauma Nursing Leaders and Staff Align?

With increased demand for registered nurses (RN), due to increasing shortage and turnover rate, the role of meaningful recognition becomes of paramount importance. We hypothesized that RNs and leaders value forms of recognition differently, due to generational gap and changing health care environment. This study included 46 RN/support staff (RN/SS group) and 10 nurse leaders (leaders group) from a Level 1 trauma center. Mean values from 5-point Likert scale survey on 31 forms of recognition (grouped into 6 categories) and demographics (age, nursing experience, and gender) were compared. All participants were separated into groups: 35 years of age and younger (millennials; n = 29) and older than 35 years (Gen X/boomers; n = 27). Majority of RN/SS were 26-35 years of age (43.5%) and 50.0% had less than 3 years of nursing experience. Half of the leaders were 36-45 years of age (p = .01 vs. RN/SS), and 70.0% had 16 years of experience or greater (p = .001). There was 9:1 female-to-male ratio in both groups (p = .8). The RN/SS rated "salary increase" highest and leaders rated "celebration for years of service" highest (both means: 4.4). When categorized, "monetary rewards" ranked highest both by RN/SS and leaders (means: 4.4 and 4.1). Overall, there was no statistically significant difference between mean values. The Gen X/boomers rated statistically significantly higher 9 forms and 3 categories (written/public acknowledgment and private verbal feedback) than millennials. Mean values for forms/categories of recognition were lower for RN/SS than for leaders, but differences were not statistical. Age drove the most difference in most meaningful forms, as preference for monetary rewards stems from the younger generations' focus on work-life balance.