Geriatric Trauma Centres – Effects on Quality of Care?

Abstract: With the aging population in Germany, the incidence of fragility fractures is increasing significantly. To improve the care of these patients, geriatric trauma centres (ATZ-DGU) have been established by the German Society for Trauma Surgery (DGU). These centres differ from pure orthogeriatric co-management (OGCM) by more comprehensive requirements regarding process quality, outcome quality, prevention, and continuity of care.The evidence is strongest for hip fractures: studies demonstrate significantly reduced mortality, improved mobility, and increased prescription rates of osteoporosis medication in ATZs. For other fracture types-such as distal radius, pelvic ring, spinal, and proximal humerus fractures-the evidence base is weaker and more heterogeneous. Although improvements in process indicators, including early mobilisation, complication detection, and osteoporosis treatment, have been observed, a clear mortality benefit has generally not been confirmed.Health insurance claims data suggest advantages of both OGCM and ATZs, such as lower rates of nursing home admission, longer fracture-free intervals, and reduced rehospitalisation rates. At the same time, higher costs and longer hospital stays are reported. Overall, ATZs demonstrate clear qualitative improvements in care, although there are no robust prospective multicentre studies to confirm patient-relevant outcomes beyond hip fractures.Geriatric trauma centres improve quality of care primarily through structured processes, prevention, and interdisciplinary collaboration. A proven mortality benefit has so far been demonstrated unequivocally only for hip fractures. Further research is needed for other fracture types, particularly to delineate the differences between OGCM and certified ATZs.