Evidence-based review of trauma center care and routine palliative care processes for geriatric trauma patients; a collaboration from the American Association for the Surgery of Trauma (AAST) Patient Assessment Committee, the AAST Geriatric Trauma Committee, and the Eastern Association for the Surgery of Trauma Guidelines Committee

Background Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients. Methods A priori questions were created regarding outcomes for patients age 65+ with respect to care at trauma centers versus non trauma centers and use of routine palliative care processes. A query of MEDLINE, PubMed, Cochrane Library, and Embase was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. GRADE methodology was used to perform a systematic review and create recommendations. Results: We reviewed 7 articles relevant to trauma center care and 9 articles reporting results on palliative care processes as they related to geriatric trauma patients. Given data quality and limitations, we conditionally recommend trauma center care for the severely injured geriatric trauma patients, but are unable to make a recommendation on the question of routine palliative care processes for geriatric trauma patients. Conclusion As our older adult population increases, injured geriatric patients will continue to pose challenges for care, such as comorbidities or frailty. We found that trauma center care was associated with improved outcomes for geriatric trauma patients in most studies, and that utilization of early palliative care consultations was generally associated with improved secondary outcomes, such as length of stay, however inconsistency and imprecision prevented us from making a clear recommendation for this question. As caregivers, we should ensure adequate support for trauma systems and palliative care processes in our institutions and communities and continue to support robust research to study these and other aspects of geriatric trauma. Level of Evidence Systematic review/guideline, Level III Correspondence/reprints: Marie Crandall, MD, MPH, FACS, Professor of Surgery, Associate Chair for Research, University of Florida College of Medicine Jacksonville, 655 W. 8th Street, Jacksonville, FL 32209. 904 244 6631 Funding: none © 2018 Lippincott Williams & Wilkins, Inc.

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