Elderly trauma patients at high risk for post-discharge mortality
LAKE BUENA VISTA, FLA. – Nearly one-quarter of discharge, according to a study presented at the Eastern Association for the Surgery of Trauma Scientific Assembly.
These findings emphasize a need to know more about geriatric patient outcomes, especially as a tide of elderly trauma patients has begun to sweep through trauma centers, according to presenter Ciara Huntington, MD, a surgical resident at the Carolinas Healthcare System, Charlotte, N.C.
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“Already, more than 30% of admissions, and $9 billion of expenditures in the United States, go toward patients aged 65 years and older, and those costs are expected to rise,” said Dr. Huntington. “We know that geriatric patients have higher costs because of undertriage and higher injury severity scores, but what we don’t know is what their long-term outcomes are.”
Investigators studied 6,285 geriatric patients in the ACS-verified Level 1 trauma registry between 2009 and 2015, and cross-referenced those files with the Social Security Death Index.
Patients were an average of 78.6 years, and the majority were female (57%) and white (85.7%). Average length of stay of was 6.7 days with an average injury severity score of 11, with a median time to death of 225 days.
While 5,780 patients were alive at discharge, 1,519 (24.2%) were dead within 1 year of hospitalization.
In a comparison of geriatric trauma patients against those of similar age in the general population, geriatric patients within the trauma population had a significantly lower life expectancy across all ages.
For trauma patients aged 65-70 years, life expectancy was estimated at 1.52 years, compared with 18.79 years for those in the general population.
Discharge location may have an impact on mortality, according to Dr. Huntington and her colleagues, who found geriatric patients discharged to their homes had a 1-year mortality rate of 13.5%, compared with 22.6% of those discharged to acute inpatient rehab centers, and 53.7% of those sent to skilled nursing facilities.
Another factor may be mechanism of injury, as the 1-year mortality of trauma patients who had fallen (27%) was nearly double the rate of those in motor vehicle crashes (15%).
Falls also were the most common injury, accounting for around 75% of the hospitalizations in the study.
In a question-and-answer session after the presentation, audience members asked about how these findings will help improve palliative care for geriatric trauma patients.
“The goal of this research is to have better predictive models and also to have better conversations” with families about the potential outcomes of trauma in these elderly patients, Dr. Huntington responded. Knowing the risk of 1-year mortality can change “how families can plan to spend time with their loved ones and how to make more appropriate medical decisions by incorporating quantitative data into the conversation.”
Dr. Huntington and her colleagues reported no relevant financial disclosures.
SOURCE: EAST 2018, Abstract #47.
