The effect of geriatric comanagement (gc) in geriatric trauma patients treated in a level 1 trauma setting: a comparison of data before and after the implementation of a certified geriatric trauma center

NOTICE: The original data files published with this dataset have been
removed due to non-compliance with Dryad guidelines for publishing human
subjects data. ************** **Introduction: **Improvements in
life expectancy imply that an increase of geriatric trauma patients
occurs. These patients require special attention due to their multiple
comorbidity issues. The aim of this study was to assess the impact of the
implementation of geriatric comanagement (GC) on the allocation and
clinical outcome of geriatric trauma patients. **Methods: **This
observational cohort study aims to compare the demographic development and
the clinical outcome in geriatric trauma patients (aged 70 years and
older) before and after implementation of a certified geriatric trauma
center (GC). Geriatric trauma patients admitted between January 1, 2010
and December 31, 2010 were stratified to group pre-GC and admissions
between January 1,  2018 and December 31, 2018 to Group post-GC.
We excluded patients requiring end-of-life treatment and those who died
within 24 h or due to severe traumatic brain injury. Outcome parameters
included demographic changes, medical complexity (measured by American
Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index
(CCI)), in-hospital mortality and length of hospitalization.
**Results: **This study includes 626 patients in Group pre-GC
(mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age
81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC
included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC
and 5.1 (± 2.0) points in post-GC (p <0.001). In Group pre-GC, 100
patients (16.0%) were stratified as ASA 1 compared with 47 patients (5.6%)
in Group post-GC (p <0.001). Group pre-GC had significantly less
patients stratified as ASA 3 or higher (n = 235, 37.5%) compared with
Group post-GC (n = 389, 46.3%, p <0.001). Length of stay (LOS)
decreased significantly from 10.4 (± 20.3) days in Group pre-GC to 7.9
(±22.9) days in Group post-GC (p = 0.011). The 30-day mortality rate was
comparable amongst these groups (pre-GC 8.8% vs. post-GC 8.9%).
Conclusion: This study appears to support the implementation of a
geriatric trauma center, as certain improvements in the patient care were
found: Despite a higher CCI and a higher number of patients with higher
ASA classifications, Hospital LOS, complication rates and mortality did
were not increased after implementation of the CG. The increase in the
case numbers supports the fact that a higher degree of specialization
leads to a response by admitting physicians, as it exceeded the expectable
trend of demographic ageing. We feel that a larger data base, hopefully in
a multi center set up should be undertaken to verify these results.

**公告**：本数据集配套发布的原始数据文件因不符合Dryad平台关于人类受试者数据的发布规范已被移除。

**引言**：预期寿命的提升意味着老年创伤患者群体规模持续扩大。此类患者因存在多种合并症，需接受针对性特殊诊疗。本研究旨在评估老年创伤多学科共管（geriatric comanagement, GC）方案的实施，对老年创伤患者诊疗资源分配与临床结局的影响。

**方法**：本观察性队列研究旨在对比70岁及以上老年创伤患者在认证老年创伤中心（GC）实施前后的人口统计学特征变化与临床结局。将2010年1月1日至2010年12月31日期间收治的老年创伤患者划为GC实施前组，2018年1月1日至2018年12月31日期间收治的患者划为GC实施后组。本研究排除了需接受临终关怀、24小时内死亡或因重度颅脑损伤死亡的患者。结局指标包括人口统计学变化、医疗复杂度（以美国麻醉医师协会评分（American Society of Anaesthesiology Score, ASA）与查尔森合并症指数（Charlson Comorbidity Index, CCI）衡量）、院内死亡率与住院时长（Length of stay, LOS）。

**结果**：本研究共纳入GC实施前组患者626例（平均年龄80.3±6.7岁），GC实施后组患者841例（平均年龄81.1±7.3岁）。GC实施前组男性患者244例（占比39.0%），GC实施后组男性患者361例（占比42.9%）。GC实施前组患者的平均CCI为4.7±1.8分，GC实施后组为5.1±2.0分（p<0.001）。GC实施前组中100例患者（16.0%）被评为ASA 1级，而GC实施后组仅47例（5.6%，p<0.001）。GC实施前组ASA 3级及以上患者占比显著低于GC实施后组[235例（37.5%）vs 389例（46.3%），p<0.001]。患者住院时长从GC实施前组的10.4±20.3天显著降至GC实施后组的7.9±22.9天（p=0.011）。两组的30天死亡率无显著差异（GC实施前组8.8% vs GC实施后组8.9%）。

**结论**：本研究结果支持认证老年创伤中心的建设与实施，患者诊疗质量得到了一定改善：尽管实施后患者的CCI评分更高、ASA分级较高的患者占比上升，但住院时长、并发症发生率与死亡率并未出现升高。收治病例数的增加表明，专科化程度的提升可促使接诊医师积极收治患者，其增速超过了人口老龄化的预期趋势。我们认为，未来应开展多中心研究以扩大样本量，从而验证本研究结论。