Impact of modified geriatric trauma activation criteria at a Level 1 Trauma Center on cost of patient care, a Retrospective Cohort Study
Reginald Alouidor, MD FACS Sandy Roh, MD Margarette Siu, MD Vincent Reginald Narvaez, MD Andrew Litwin, MD Aixa Perez-Carabello, MS MPH Nicole Corriveau Kristine Kramer, MD Edward Kelly, MD FACS Eleanor Winston, MD FACS Tyler Putnam, MD FACS Gabriel Ryb, MD FACS
University of Massachusetts Medical Center-Baystate Health, Springfield, MA
Background: Statistical comparison of total cost of care between geriatric trauma patients prior to and after implementation of Modified Geriatric Trauma Activation Criteria.
Methods: A retrospective study from 2015-2019 at an academic level 1 Trauma Center. All adults > 65 seen as Category 1 or 2 trauma activation, or trauma consultation. Modified geriatric trauma activation criteria were implemented 3/1/2017 calling for an upgrade of CAT 1 to CAT 2 based on age > 65. Variables of patient age, mechanism of injury, comorbidities, level of trauma activation, outcomes, ISS, operative intervention, cost at 24 and 48 hours were collected. Continuous measures were reported using means, standard deviations, medians, and percentiles. Categorical measures were reported using frequencies and percentages. Differences in subject characteristics between study groups, before and after implementation of modified criteria, were analyzed.
Results: The standard activation group (n=614) and the study group (n=574) were similar in size. ISS, mechanism of injury, and comorbidities were not statistically different (p=0.35, 0.08, 0.6, respectively). Modified Geriatric Trauma Activation criteria lead to increased CAT 1 activations, n=58 before and n=145 after. Death in ED and at 30 days was not statistically different between the two groups (p=0.48 and 0.5, respectively). Cost at 24 hours before modified criteria was $12493.60 and after was $14253.60 (p=0.03). Cost at 48 hours between the groups was not statistically different (p=0.26).
Conclusion: Our results show that Modified Geriatric Trauma Activation Criteria increased the total cost of patient care at the first 24hours without improving survival for geriatric trauma patients.
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