Using Trauma Triage Score to Risk-Stratify Inpatient Triage, Hospital Quality Measures, and Cost in Middle-Aged and Geriatric Orthopaedic Trauma Patients

J Orthop Trauma. 2019 Oct;33(10):525-530. doi: 10.1097/BOT.0000000000001561.

Abstract

Objectives: To investigate the efficacy of a novel geriatric trauma risk assessment tool [Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA)] designed to predict inpatient mortality to risk-stratify measures of hospital quality and cost of care in middle-aged and geriatric orthopaedic trauma patients.

Design: Prospective cohort study.

Setting: Academic medical center.

Patients: One thousand five hundred ninety-two patients 55 years of age and older who were evaluated by orthopaedic surgery in the emergency department between October 1, 2014, and September 30, 2016.

Intervention: Calculation of the inpatient mortality risk score (STTGMA) using each patient's demographics, injury severity, and functional status. Patients were stratified into minimal-, low-, moderate-, and high-risk cohort groups based on risk of <0.9%, 0.9%-1.9%, 1.9%-5%, and >5%.

Main outcome measurements: Length of stay, complications, disposition, readmission, and cost.

Results: One thousand two hundred seventy-eight patients (80.3%) sustained low-energy injuries and 314 patients (19.7%) sustained high-energy injuries. The average age was 73.8 ± 11.8 years. The mean length of hospital stay was 5.2 days with a significant difference between the STTGMA risk groups. This risk stratification between groups was also seen in complication rate, need for Intensive Care Unit/Step Down Unit care, percentage of patients discharged, and readmission within 30-days. The mean total cost of admission for the minimal-risk group was less than one-third that of the high-risk cohort.

Conclusions: The STTGMA tool is able to risk-stratify hospital quality outcome measures and cost. Thus, it is a valuable clinical tool for health care providers in identifying high-risk patients in efforts to continue to provide high-quality resource conscious care to orthopaedic trauma patients.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Geriatric Assessment*
  • Health Care Costs*
  • Hospitalization*
  • Hospitals / standards*
  • Humans
  • Musculoskeletal System / injuries*
  • Musculoskeletal System / surgery*
  • Orthopedic Procedures / economics*
  • Prospective Studies
  • Quality Indicators, Health Care*
  • Risk Assessment / methods*
  • Triage / methods*