Ability of a Risk Prediction Tool to Stratify Quality and Cost for Older Patients With Tibial Shaft and Plateau Fractures

Objectives: To determine whether a validated trauma triage tool can identify the middle-aged and geriatric trauma patients with tibial shaft and plateau fractures who are at the risk for costly admissions and poorer hospital quality measures. Design: Prospective cohort study. Setting: Level-1 trauma center. Patients/Participants: Sixty-four patients older than 55 years hospitalized with isolated tibial shaft or plateau fractures. Intervention: Patients with either isolated tibial plateau fractures or tibial shaft fractures over a 3-year period were prospectively enrolled in an orthopedic trauma registry. Demographic information, injury severity, and comorbidities were assessed and incorporated into the Score for Trauma Triage in Geriatric and Middle Aged (STTGMA) score, a validated trauma triage score that calculates inpatient mortality risk upon admission. Patients were then grouped into tertiles based on their STTGMA score. Main Outcome Measures: Length of stay, complications, discharge location, and direct variable costs. Results: Sixty-four patients met inclusion criteria. Thirty-three patients (51.6%) presented with tibial plateau fractures and 31 (48.4%) with tibial shaft fractures. The mean age was 66.7 +/- 10.2 years. Mean length of stay was significantly different between risk groups with a mean of 6.8 +/- 4 days (P< 0.001). Although 19 (90.5%) of the minimal risk patients were discharged home, only 7 (33.3%) and 5 (22.7%) of moderate- and high-risk patients were discharged home, respectively (P< 0.001). Higher-risk patients experienced a significantly greater number of complications during hospitalization but had no differences in the need for intensive care unit-level care (P= 0.027 andP= 0.344, respectively). The total cost difference between the lowest- and highest-risk group was nearly 50% ($14,070 +/- 8056 vs. $25,147 +/- 14,471; mean difference, $11,077;P= 0.022). Conclusion: Application of the STTGMA triage tool allows for the prediction of key hospital quality measures and cost of hospitalization that can improve clinical decision-making.