Delirium in Hospitalized Trauma Surgery Patients Cared by Geriatric Trauma Co-Management and Standard Care: A Propensity Score-Matched Analysis.

INTRODUCTION

Delirium is common in hospitalized older adults and is associated with higher morbidity and mortality in this population. Our geriatric trauma co-management (GTC) program integrates a geriatrician in the trauma team, with a focus on team-based, interdisciplinary care coordination to mitigate geriatric syndromes, including delirium.

METHODS

We analyzed 12,631 patients aged 65 and older admitted to the trauma surgery team at a level-1 trauma center from 2017 to 2024. We perform a 1:1 ratio matching of propensity scores. The primary outcome was delirium incidence, defined by acute encephalopathy, positive Confusion Assessment Method (CAM) score, or new use of antipsychotic medicine between GTC and usual standard care (UC). The secondary outcomes included discharge disposition, in-hospital falls, intensive care unit (ICU) length of stay (LOS), mortality, and 30-day readmission. Chi-square and Students's t tests were used for bivariate analyses. Multivariate linear or logistic regression analyses were used for outcomes. When applicable, the analyses were adjusted.

RESULTS

The propensity score-matched cohort included 1,318 patients (659 GTC; 659 UC). Mean age was 82.1 ± 8.1 years, 45% were male. GTC patients had a 37% higher likelihood of being discharged to SNF (1.37 [1.04-1.79]). The mean ICU LOS was higher in the GTC group (3.9 ± 5.7 days vs. 2.3 ± 3.7 days, adjusted p = 0.002), but there were no significant differences in mean LOS, in-hospital falls, in-hospital mortality, discharge to hospice or death during hospitalization, death within 30 days after discharge, or 30-day readmissions. For the prespecified composite delirium outcome, GTC patients had higher documented delirium (51.9%) compared with 28.1% for UC patients (2.50 [1.88-3.34]). Secondary exploratory analyses of individual delirium definitions showed higher rates of acute encephalopathy occurred in 7.6% of GTC patients versus 1.2% of UC patients (OR 14.80, 95% CI [4.82-45.45]; p < 0.0001). Positive CAM score was documented in 42.6% of GTC patients compared with 11.1% of UC patients (4.68 [3.23-6.78]; p < 0.0001). Positive CAM score and/or new use of antipsychotic medicine occurred in 27.2% of GTC patients versus 22.2% of UC patients (1.38 [1.02-1.87]; p = 0.038). In contrast, new antipsychotic alone was more common in UC (15.8% vs. 7.9%, p < 0.05). Among patients with a positive CAM score, GTC patients had lower in-hospital mortality compared with UC (8.2% vs. 18.4%; OR 0.40, 95% CI: 0.17-0.95; p < 0.05).

CONCLUSION

GTC in older trauma patients helps identify delirium and potentially reduces the need for antipsychotics and improves mortality. A randomized controlled trial is needed to verify these findings.