Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review
Objective To systematically review research on acute hospital care for frail or older adults experiencing moderate to major trauma.Setting Electronic databases (Medline, Embase, ASSIA, CINAHL Plus, SCOPUS, PsycINFO, EconLit, The Cochrane Library) were searched using index and key words, and referenc...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-02-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/2/e066329.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849773402302185472 |
|---|---|
| author | Phil Moss Heather Jarman Mary Halter Mark Baxter Stefan Tino Kulnik Lucia Gavalova Robert Crouch Elaine Cole Desislava Baramova |
| author_facet | Phil Moss Heather Jarman Mary Halter Mark Baxter Stefan Tino Kulnik Lucia Gavalova Robert Crouch Elaine Cole Desislava Baramova |
| author_sort | Phil Moss |
| collection | DOAJ |
| description | Objective To systematically review research on acute hospital care for frail or older adults experiencing moderate to major trauma.Setting Electronic databases (Medline, Embase, ASSIA, CINAHL Plus, SCOPUS, PsycINFO, EconLit, The Cochrane Library) were searched using index and key words, and reference lists and related articles hand-searched.Included articles Peer-reviewed articles of any study design, published in English, 1999–2020 inclusive, referring to models of care for frail and/or older people in the acute hospital phase of care following traumatic injury defined as either moderate or major (mean or median Injury Severity Score ≥9). Excluded articles reported no empirical findings, were abstracts or literature reviews, or referred to frailty screening alone.Methods Screening abstracts and full text, and completing data extractions and quality assessments using QualSyst was a blinded parallel process. A narrative synthesis, grouped by intervention type, was undertaken.Outcome measures Any outcomes reported for patients, staff or care system.Results 17 603 references were identified and 518 read in full; 22 were included—frailty and major trauma (n=0), frailty and moderate trauma (n=1), older people and major trauma (n=8), moderate or major trauma (n=7) 0r moderate trauma (n=6) . Studies were observational, heterogeneous in intervention and with variable methodological quality.Specific attention given to the care of older and/or frail people with moderate to major trauma in the North American context resulted in improvements to in-hospital processes and clinical outcomes, but highlights a relative paucity of evidence, particularly in relation to the first 48 hours post-injury.Conclusions This systematic review supports the need for, and further research into an intervention to address the care of frail and/or older patients with major trauma, and for the careful definition of age and frailty in relation to moderate or major trauma.International Prospective Register of Systematic Reviews (PROSPERO) CRD42016032895. |
| format | Article |
| id | doaj-art-20da5394ad9548eba5f498e765285bdb |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-20da5394ad9548eba5f498e765285bdb2025-08-20T03:02:04ZengBMJ Publishing GroupBMJ Open2044-60552023-02-0113210.1136/bmjopen-2022-066329Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic reviewPhil Moss0Heather Jarman1Mary Halter2Mark Baxter3Stefan Tino Kulnik4Lucia Gavalova5Robert Crouch6Elaine Cole7Desislava Baramova8Emergency department, St George`s University Hospitals NHS Foundation Trust, London, UKEmergency Department Clinical Research Unit, St George`s University Hospitals NHS Foundation Trust, London, UKFaculty of Health, Social Care and Education, Kingston University and St George`s University of London, London, UK5 Trauma and Orthopaedic Department, University Hospital Southampton NHS Foundation Trust, Southampton, UKFaculty of Health, Social Care and Education, Kingston University and St George`s, University of London, London, UKFaculty of Health, Social Care and Education, Kingston University and St George`s University of London, London, UKHealth Sciences, University of Southampton, Southampton, UK2 Queen Mary University of London, London, UKEmergency Department, St George`s University Hospitals NHS Foundation Trust, London, UKObjective To systematically review research on acute hospital care for frail or older adults experiencing moderate to major trauma.Setting Electronic databases (Medline, Embase, ASSIA, CINAHL Plus, SCOPUS, PsycINFO, EconLit, The Cochrane Library) were searched using index and key words, and reference lists and related articles hand-searched.Included articles Peer-reviewed articles of any study design, published in English, 1999–2020 inclusive, referring to models of care for frail and/or older people in the acute hospital phase of care following traumatic injury defined as either moderate or major (mean or median Injury Severity Score ≥9). Excluded articles reported no empirical findings, were abstracts or literature reviews, or referred to frailty screening alone.Methods Screening abstracts and full text, and completing data extractions and quality assessments using QualSyst was a blinded parallel process. A narrative synthesis, grouped by intervention type, was undertaken.Outcome measures Any outcomes reported for patients, staff or care system.Results 17 603 references were identified and 518 read in full; 22 were included—frailty and major trauma (n=0), frailty and moderate trauma (n=1), older people and major trauma (n=8), moderate or major trauma (n=7) 0r moderate trauma (n=6) . Studies were observational, heterogeneous in intervention and with variable methodological quality.Specific attention given to the care of older and/or frail people with moderate to major trauma in the North American context resulted in improvements to in-hospital processes and clinical outcomes, but highlights a relative paucity of evidence, particularly in relation to the first 48 hours post-injury.Conclusions This systematic review supports the need for, and further research into an intervention to address the care of frail and/or older patients with major trauma, and for the careful definition of age and frailty in relation to moderate or major trauma.International Prospective Register of Systematic Reviews (PROSPERO) CRD42016032895.https://bmjopen.bmj.com/content/13/2/e066329.full |
| spellingShingle | Phil Moss Heather Jarman Mary Halter Mark Baxter Stefan Tino Kulnik Lucia Gavalova Robert Crouch Elaine Cole Desislava Baramova Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review BMJ Open |
| title | Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review |
| title_full | Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review |
| title_fullStr | Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review |
| title_full_unstemmed | Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review |
| title_short | Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review |
| title_sort | configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma a systematic review |
| url | https://bmjopen.bmj.com/content/13/2/e066329.full |
| work_keys_str_mv | AT philmoss configurationsandoutcomesofacutehospitalcareforfrailandolderpatientswithmoderatetomajortraumaasystematicreview AT heatherjarman configurationsandoutcomesofacutehospitalcareforfrailandolderpatientswithmoderatetomajortraumaasystematicreview AT maryhalter configurationsandoutcomesofacutehospitalcareforfrailandolderpatientswithmoderatetomajortraumaasystematicreview AT markbaxter configurationsandoutcomesofacutehospitalcareforfrailandolderpatientswithmoderatetomajortraumaasystematicreview AT stefantinokulnik configurationsandoutcomesofacutehospitalcareforfrailandolderpatientswithmoderatetomajortraumaasystematicreview AT luciagavalova configurationsandoutcomesofacutehospitalcareforfrailandolderpatientswithmoderatetomajortraumaasystematicreview AT robertcrouch configurationsandoutcomesofacutehospitalcareforfrailandolderpatientswithmoderatetomajortraumaasystematicreview AT elainecole configurationsandoutcomesofacutehospitalcareforfrailandolderpatientswithmoderatetomajortraumaasystematicreview AT desislavabaramova configurationsandoutcomesofacutehospitalcareforfrailandolderpatientswithmoderatetomajortraumaasystematicreview |