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

TLDR: The STTGMA tool is able to risk stratify hospital quality outcome measures and cost and 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.

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 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.