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

OBJECTIVES
Investigate the efficacy of a novel geriatric trauma risk assessment tool (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:: 1592 patients aged 55 and older who were evaluated by orthopaedic surgery in the emergency department between 10/1/2014-9/30/2016.


INTERVENTION
Calculation of 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:: 1278 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 ICU/SDU care, percentage of patients discharged home, 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.