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Abstract

Introduction: The geriatric population is a rapidly expanding demographic, clearly reflected by increases in the prevalence of geriatric trauma seen at trauma centers. By creating subdivisions within the traditional paradigm, our study sought to further delineate differences in demographics and quantify outcomes of our geriatric trauma population. We report here that at a breakpoint of 80 years old, a significant shift in our geriatric cohort occurs and correlates with worsening outcomes. Methods: A retrospective chart review was performed at a single urban Level I trauma center using trauma registry data from 2006 to 2011, including trauma patients ≥65 years old for analysis of age, gender, Injury Severity Score (ISS), comorbidities, mechanisms of injury (MOI), ICU and hospital length of stay (LOS), mortality, and discharge destination. The geriatric population was divided into three groups for analysis: Group 1: 65–79 years old, Group 2: 80–89 years old, and Group 3: ≥90 years old. Statistical analyses were performed using t-tests and Fisher’s exact tests; p<0.05 was considered significant. Results: A total of 5261 patients were included in the study, with 2487 in Group 1, 2222 in Group 2, and 552 in Group 3. There were significantly more females in Group 3 at 70% compared to only 49% in Group 1. Average ISS only differed significantly between Group 1 (12.8) and Group 2 (13.6). Diabetes incidence decreased as age increased, 28.6% to 23.7% to 16.6% respectively; as did obesity decreasing from 5.3% in Group 1 to 0.3% in Group 3. Alzheimers and dementia significantly increased from 7.5% in Group 1 to 31.8% in Group 3. The most common MOI was falls, peaking at 93.1% in Group 3. Mortality was significantly increased in Groups 2 and 3 (9.5%, 10%) compared to Group 1 (5.6%). ICU LOS decreased from 6 days in Group 1 to 4 days in Groups 2 and 3, where ICU mortality increased from 9.8% in Group 1 to 15.3% and 13.7% in Groups 2 and 3. Of survivors, rate of discharge to home significantly decreased from 54% in Group 1 to 29% and 22% in Groups 2 and 3. All comparisons above are statistically significant unless otherwise noted. Conclusions: Our analysis illustrates that there is a relevant difference in outcomes and demographics within the geriatric population when stratified by age. Greater than 80 years old appears to be a breaking point for changes in demographics and worsening outcomes. Obviously outcomes worsen with age; however, this data provides a well-characterized threshold when caring for a vulnerable population with regard to goals of care and end of life decision-making.