{"id":22612,"date":"2022-10-11T04:18:00","date_gmt":"2022-10-10T20:18:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22612"},"modified":"2022-10-11T08:04:27","modified_gmt":"2022-10-11T00:04:27","slug":"jama-surg%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%ae%9e%e6%96%bd%e8%80%81%e5%b9%b4%e6%82%a3%e8%80%85%e5%88%9b%e4%bc%a4%e4%b8%b4%e5%ba%8a%e8%b7%af%e5%be%84%e4%b8%8e%e8%b0%b5%e5%a6%84%e5%8f%91","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22612","title":{"rendered":"[JAMA Surg\u53d1\u8868\u8bba\u6587]\uff1a\u5b9e\u65bd\u8001\u5e74\u60a3\u8005\u521b\u4f24\u4e34\u5e8a\u8def\u5f84\u4e0e\u8c35\u5984\u53d1\u751f\u7387\u6539\u53d8\u7684\u76f8\u5173\u6027"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

June 8, 2022<\/p>\n\n\n\n

Association Between Implementation of a Geriatric Trauma Clinical Pathway and Changes in Rates of Delirium in Older Adults With Traumatic Injury<\/h1>\n\n\n\n

Caroline\u00a0Park,\u00a0Ankur\u00a0Bharija,\u00a0Matthew\u00a0Mesias,\u00a0et al<\/h3>\n\n\n\n

JAMA Surg.\u00a0<\/em>2022;157(8):676-683. doi:10.1001\/jamasurg.2022.1556<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Is the establishment of a geriatric-centered clinical pathway associated with improved outcomes in older adults with traumatic injury?<\/p>\n\n\n\n

Findings<\/strong>  In this case-control study of 712 older adults with traumatic injury in a single level I trauma center, outcomes before and after implementation of a novel clinical pathway were compared. Reductions in delirium in unadjusted analyses and adjusted analyses were noted.<\/p>\n\n\n\n

Meaning<\/strong>  In this case-control study, implementation of a multidisciplinary care pathway was associated with improved rates of delirium.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Older adults (age \u226565 years) are at risk for high rates of delirium and poor outcomes; however, how to improve outcomes is still being explored.<\/p>\n\n\n\n

Objective<\/strong>  To assess whether implementation of a geriatric trauma clinical pathway was associated with reduced rates of delirium in older adults with traumatic injury.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  A retrospective case-control study of electronic health records of patients aged 65 years or older with traumatic injury from 2018 to 2020 was conducted at a single level I trauma center. Eligible patients were age 65 years or older admitted to the trauma service and who did not undergo an operation.<\/p>\n\n\n\n

Intervention<\/strong>  The implementation of a clinical pathway based on geriatric best practices, which included order sets, guidelines, automated consultations, and escalation pathways executed by a multidisciplinary team.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was delirium. The secondary outcome was hospital length of stay. Process measures for pathway compliance were also assessed.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Of the 859 eligible patients, 712 patients were included in the analysis (442 [62.1%] in the baseline group; 270 [37.9%] in the postimplementation group; mean [SD] age: 81.4 [9.1] years; 394 [55.3%] were female). The mechanism of injury was not different between groups, with 247 in the baseline group (55.9%) and 162 in the postimplementation group (60.0%) (P<\/em>\u2009=\u2009.43) experiencing a fall. Injuries were minor or moderate in both groups (261 in baseline group [59.0%] and 168 in postimplementation group [62.2%];\u00a0P<\/em>\u2009=\u2009.87). The adjusted odds ratio for delirium in the postimplementation cohort was 0.54 (95% CI, 0.37-0.80;\u00a0P<\/em>\u2009<\u2009.001). Goals of care documentation improved significantly in the postimplementation cohort vs the baseline cohort with regard to documented goals of care notes (53.7% in the postimplementation cohort [145 of 270] vs 16.7% in the baseline cohort [74 of 442];\u00a0P<\/em>\u2009<\u2009.001) and a shortened time to discussion from presenting to the emergency department (36 hours in the postimplementation cohort vs 50 hours in the baseline cohort;\u00a0P<\/em>\u2009=\u2009.03).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this study, implementation of a multidisciplinary clinical pathway for injured older adults at a single level I trauma center was associated with improved care and clinical outcomes. Interventions such as these may have utility in this vulnerable population, and findings should be confirmed across multiple centers.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  June 8, 2022 Association B […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22612"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22612"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22612\/revisions"}],"predecessor-version":[{"id":22613,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22612\/revisions\/22613"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22612"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22612"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22612"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}