{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:17:47Z","timestamp":1790381867999,"version":"4.1.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2022,8,1]]},"abstract":"<jats:sec id=\"ab-soi220027-4\"><jats:title>Importance<\/jats:title><jats:p>Older adults (age \u226565 years) are at risk for high rates of delirium and poor outcomes; however, how to improve outcomes is still being explored.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220027-5\"><jats:title>Objective<\/jats:title><jats:p>To assess whether implementation of a geriatric trauma clinical pathway was associated with reduced rates of delirium in  older adults with traumatic injury.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220027-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A retrospective case-control study of electronic health records of patients aged 65 years or older with traumatic injury from 2018 to 2020 was conducted at a single level I trauma center. Eligible patients were age 65 years or older admitted to the trauma service and who did not undergo an operation.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220027-7\"><jats:title>Intervention<\/jats:title><jats:p>The implementation of a clinical pathway based on geriatric best practices, which included order sets, guidelines, automated consultations, and escalation pathways executed by a multidisciplinary team.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220027-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was delirium. The secondary outcome was hospital length of stay. Process measures for pathway compliance were also assessed.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220027-9\"><jats:title>Results<\/jats:title><jats:p>Of the 859 eligible patients, 712 patients were included in the analysis (442 [62.1%] in the baseline group; 270 [37.9%] in the postimplementation group; mean [SD] age: 81.4 [9.1] years; 394 [55.3%] were female). The mechanism of injury was not different between groups, with 247 in the baseline group (55.9%) and 162 in the postimplementation group (60.0%) (<jats:italic>P<\/jats:italic>\u2009=\u2009.43) experiencing a fall. Injuries were minor or moderate in both groups (261 in baseline group [59.0%] and 168 in postimplementation group [62.2%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.87). The adjusted odds ratio for delirium in the postimplementation cohort was 0.54 (95% CI, 0.37-0.80; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Goals of care documentation improved significantly in the postimplementation cohort vs the baseline cohort with regard to documented goals of care notes (53.7% in the postimplementation cohort [145 of 270] vs 16.7% in the baseline cohort [74 of 442]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and a shortened time to discussion from presenting to the emergency department (36 hours in the postimplementation cohort vs 50 hours in the baseline cohort; <jats:italic>P<\/jats:italic>\u2009=\u2009.03).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220027-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this study, implementation of a multidisciplinary clinical pathway for injured older adults at a single level I trauma center was associated with improved care and clinical outcomes. Interventions such as these may have utility in this vulnerable population, and findings should be confirmed across multiple centers.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2022.1556","type":"journal-article","created":{"date-parts":[[2022,6,8]],"date-time":"2022-06-08T15:03:49Z","timestamp":1654700629000},"page":"676","source":"Crossref","is-referenced-by-count":43,"title":["Association Between Implementation of a Geriatric Trauma Clinical Pathway and Changes in Rates of Delirium in Older Adults With Traumatic Injury"],"prefix":"10.1001","volume":"157","author":[{"given":"Caroline","family":"Park","sequence":"first","affiliation":[{"name":"Section of Geriatrics, Division of Primary Care and Population Health, Department of Medicine, Stanford School of Medicine, Palo Alto, California"},{"name":"Department of Geriatric Medicine, Geriatric Research Education and Clinical Center (GRECC), Veterans Administration, Palo Alto Health Care System, Palo Alto, 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