Citation

Lee JS, Khan AD, Dorlac WC, Dunn J, McIntyre RCJ, Wright FL, Platnick KB, Brockman V, Vega SA, Cofran JM, Duero C, Schroeppel TJ. J. Trauma Acute Care Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000003400

PMID

unavailable

Abstract

BACKGROUND: Geriatric trauma rates are increasing, yet trauma centers often struggle to provide autonomy regarding decision making to these patients. Advance care planning can assist with this process. Currently, there are limited data on the impact of advance directives (AD) in elderly trauma patients. The purpose of this study was to evaluate the prevalence of pre-injury AD in geriatric trauma patients and its impact on outcomes, with the hypothesis that ADs would not be associated with an increase in mortality.

METHODS: A multi-center retrospective review was conducted on patients older than 65 with traumatic injury between 2017 and 2019. Three level I trauma centers and one level II trauma center were included. Exclusion criteria were readmission, burn injury, transfer to another facility, discharge from emergency department, and mortality prior to being admitted.

RESULTS: There were 6,135 patients identified; 751 (12.2%) had a pre-injury AD. Patients in the AD+group were older (86 vs 77 years, p < 0.0001), more likely to be female (67% vs 54.8%, p < 0.0001), and had more comorbidities. Hospital length of stay and ventilator days were similar. In-hospital mortality occurred in 236 patients and 75.4% of them underwent withdrawal of care (WOC). The mortality rate was higher in AD+ group (10.5% vs 2.9%, p < 0.0001). No difference was seen in the rate of AD between the WOC+ and WOC- group (31.5% vs 39.6%, p = 0.251). A pre-injury AD was identified as an independent predictor of mortality, but not a predictor of WOC.

CONCLUSION: Despite a high WOC rate in patients over 65, most patients did not have an AD prior to injury. As the elderly trauma population grows, advance care planning should be better integrated into geriatric care to encourage a patient-centered approach to end-of-life care. LEVEL OF EVIDENCE: Level IV. STUDY TYPE: Prognostic and epidemiological.

Language: en