Abstract
Introduction: Elderly patients account for approximately one third of all trauma patients, yet 50% of all deaths. In hospitalized patients specialized geriatric assessments and care have been shown to improve outcome.We sought to determine the impact of geriatric trauma on our intensive care unit to determine how resources may better be allocated. Hypothesis: We hypothesized that trauma patients over the age of 80 have significantly worse outcomes than similarly injured younger patients. Methods: The trauma database at a level I trauma center was queried for patients age 80 or above (OCT) admitted to the intensive care unit over a 3 year period. Demographics, mechanism of injury, length of stay, and disposition were recorded. This was then compared to patients less than 80 years of age for the same time period. (YNG) Results: 410 patients age? 80 years (13%) and 2679 patients under 80 years (87%) were admitted to the intensive care unit during the study period. For the older cohort, average age was 86 ± 4 years (range 80-100). OCT patients were more likely to be female (62%, n=253), Caucasian (88%, n=361), and suffer fall as mechanism of injury (80%, n=329). OCT HLOS was 7 ± 6 days, ICU LOS 3 ± 4 days, and ISS 17 ± 8. The YNG group was predominant male (72%, n=1923, p>0.001), Caucasian (69%, n=1861), with a wider variety in mechanism with only 26% falls (n=708, p<0.001). YNG cohort HLOS was longer at 10 ± 12 days (p=0.02), ICU LOS 4 ± 6 days (p=0.02), and ISS higher at 19 ± 11 (p=0.002). Only 18% (n=74) of OCT were discharged to home independently compared to 52% (n=1250) of YNG. (p<0.001) In contrast, the majority of OCT were discharged to a skilled nursing facility (47%, n=150), compared to only 10% of YNG (n=230). (p<0.001) Mortality overall was 13%, with 22% OCT mortality compared to 11% YNG mortality (p<0.001). Conclusions: OCT patients comprise 13% of our ICU admission, yet constitute one quarter of deaths. They are hospitalized just over a week on average, however few return to independence. This represents a significant strain on the healthcare system as a whole. These unique characteristics warrant creation of a specialized care team to properly care for geriatric trauma patients.
Published Version
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