Evidence map›Paper›PMID 30633098›Full record

ArticleThe journal of trauma and acute care surgery2019

Complications in low-risk older adult trauma patients: A case-control study.

Robert A Tessler, Melissa M Rangel, Micaela L Rosser, Frederick P Rivara, Eileen Bulger, Monica S Vavilala, May J Reed, Saman Arbabi

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Article in The journal of trauma and acute care surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Robert A TesslerFrom the Harborview Injury Prevention and Research Center (R.A.T., F.P.R., E.B., M.S.V., S.A.), Seattle, Washington; School of Medicine (M.M.R., M.L.R.), University of Washington, Seattle, Washington; Department of Pediatrics (F.P.R.), University of Washington, Seattle, Washington; Department of Surgery (E.B., S.A), University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine (M.S.V.), University of Washington, Seattle, Washington; and Division of Gerontology and Geriatric Medicine (M.J.R.), University of Washington, Seattle, Washington.
Melissa M Rangel
Micaela L Rosser
Frederick P Rivara
Eileen Bulger
Monica S Vavilala
May J Reed
Saman Arbabi

Funding

Pediatric Injury Research Training ProgramT32HD057822 · NICHD · UNIVERSITY OF WASHINGTON · PI CAROLYN A MC CARTY, Ali Rowhani-Rahbar · 2010 to 2026
$4.0M
NICHD NIH HHS T32 HD057822
6 · The paper itself

Abstract

backgroundAlthough some geriatric trauma patients may be at low risk of complications, poor outcomes are pronounced if complications do occur. Prevention in this group decreases the risk of excess morbidity and mortality.

methodsWe performed a case-control study of trauma patients 65 years or older treated from January 2015 to August 2016 at a Level I trauma center with a Trauma Quality Improvement Program-predicted probability of complication of less than 20%. Cases had one of the following complications: unplanned admission to the intensive care unit (ICU), unplanned intubation, pneumonia, or unplanned return to the operating room. Two age-matched controls were randomly selected for each case. We collected information on comorbidities, home medications, and early medical care and calculated odds ratios using multivariable conditional logistic regression.

resultsNinety-four patients experienced unplanned admission to ICU (n = 51), unplanned intubation (n = 14), pneumonia (n = 21), and unplanned return to the operating room (n = 8). The 188 controls were more frequently intubated and had higher median ISS but were otherwise similar to cases. The adjusted odds of complication were higher for patients on a home β-blocker (adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.2-4.0) and home anticoagulation (aOR, 2.2; 95% CI, 1.2-4.1). Patients with diabetes (aOR 2.0; 95% CI, 1.1-3.7) and dementia (aOR, 2.0; 95% CI, 1.0-4.3) also had higher odds of complication. The adjusted odds of complication for patients receiving geriatrics consultation was 0.4 (95% CI, 0.2-1.0; p = 0.05). Pain service consultation and indwelling pain catheter placement may be protective, but CIs included 1. There was no association between opiates, benzodiazepines, fluid administration, or blood products in the first 24 hours and odds of complication.

conclusionsGeriatrics consultation was associated with lower odds of unplanned admission to the ICU, unplanned intubation, pneumonia, and unplanned return to the operating room in low-risk older adult trauma patients. Pathways that support expanding comanagement strategies with geriatricians are needed. LEVEL OF EVIDENCE: Therapeutic/Care management, Level IV.

Indexed as

AgedAged, 80 and overAge FactorsCase-Control StudiesFemaleHumansInjury Severity ScoreMaleRisk AssessmentRisk FactorsSex FactorsWounds and Injuries

Identifiers

PMID30633098
PMCPMC6476653

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.