Geriatric Trauma Patients Research Articles

Comments on “Effect of coolant spray on rib fracture pain of geriatric blunt thoracic trauma patients: a randomized controlled trial”

Comments on “Effect of coolant spray on rib fracture pain of geriatric blunt thoracic trauma patients: a randomized controlled trial”

Trochanteric fracture pattern is associated with increased risk for nonunion independent of open or closed reduction technique

PurposeSoft tissue injury and soft tissue injury as risk factors for nonunion following trochanteric femur fractures (TFF) are marginally investigated. The aim of this study was to identify risk factors for impaired fracture healing in geriatric trauma patients with TFF following surgical treatment with a femoral nail.MethodsThis retrospective cohort study included geriatric trauma patients (aged > 70 years) with TFF who were treated with femoral nailing. Fractures were classified according to AO/OTA. Nonunion was defined as lack of callus-formation after 6 months, material breakage, and requirement of revision surgery. Risk factors for nonunion included variables of clinical interest (injury pattern, demographics, comorbidities), as well as type of approach (open versus closed) and were assessed with uni- and multivariate regression analyses.ResultsThis study included 225 geriatric trauma patients. Nonunion was significantly more frequently following AO/OTA 31A3 fractures (N = 10, 23.3%) compared with AO/OTA type 31A2 (N = 6, 6.9%) or AO/OTA 31A1 (N = 3, 3.2%, p < 0.001). Type 31A3 fractures had an increased risk for nonunion compared with type 31A1 (OR 10.3 95%CI 2.2 to 48.9, p = 0.003). Open reduction was not associated with increased risk for nonunion (OR 0.9, 95%CI 0.1 to 6.1. p = 0.942) as was not the use of cerclage (OR 1.0, 95%CI 0.2 to 6.5, p = 0.995). Factors such as osteoporosis, polytrauma or diabetes were not associated with delayed union or nonunion.ConclusionThe fracture morphology of TFF is an independent risk factor for nonunion in geriatric patients. The reduction technique is not associated with increased risk for nonunion, despite increased soft tissue damage following open reduction.

1279: EARLY GOALS-OF-CARE DISCUSSION IN GERIATRIC TRAUMA IS ASSOCIATED WITH INCREASED CODE STATUS CHANGES

Introduction: The Trauma Quality Improvement Program guidelines recommend early goals of care (GOC) discussions within 72 hours of admission for geriatric trauma patients. Despite this recommendation family meetings and GOC conversations are often performed in a delayed fashion. We hypothesized that early GOC discussions are associated with higher incidence of goal concordant care manifested as code status changes and implementation of comfort measures only (CMO), as well as shorter hospital length of stay (LOS). Methods: A retrospective chart review was performed on patients aged ≥65 years admitted to Hartford Hospital intensive care units (ICU) with a trauma diagnosis between January 2020 and December 2021. Demographics, timing of GOC discussion, and clinical outcomes were collected. Results: Of 273 identified patients, 78% were male, and median age was 79 years (interquartile range, IQR 71 – 86). Median injury severity scale (ISS) was 13 (IQR 9 – 21), and the most common mechanism of injury was falls (77%). Only 51 (19%) had a GOC discussion documented in the chart within 72 hours of admission. In a logistic regression model adjusting for significant variables, early GOC discussion was associated with higher likelihood for changing code status (adjusted odds ratio, OR 6.0; p< 0.001) and transitioning to CMO (OR 3.4; p=0.008), compared to having GOC discussion after 72 hours or not at all. Among those who had GOC discussion during hospitalization, early GOC discussion was associated with shorter ICU LOS (β=-7.4; p=0.014) and hospital LOS (β=-10.9; p=0.008), adjusting for significant variables identified on the univariable analysis. Patients who had GOC discussion within 72 hours were at significantly lower odds of undergoing invasive procedures (OR 0.41; p=0.02). Conclusions: Early GOC discussion within 72 hours of admission is associated with higher likelihood of code status change and election of CMO in geriatric trauma patients. Interventions to increase adherence to the early GOC meeting recommendation should be emphasized at an institutional level.

Development of Imaging Criteria for Geriatric Blunt Trauma Patients

IntroductionCurrent decision tools to guide trauma computed tomography (CT) imaging were not validated for use in older patients. We hypothesized that specific clinical variables would be predictive of injury and could be used to guide imaging in this population to minimize risk of missed injury. MethodsBlunt trauma patients aged 65 y and more admitted to a Level 1 trauma center intensive care unit from January 2018 to November 2020 were reviewed for histories, physical examination findings, and demographic information known at the time of presentation. Injuries were defined using the patient's final abbreviated injury score codes, obtained from the trauma registry. Abbreviated injury score codes were categorized by corresponding CT body region: Head, Face, Chest, C-Spine, Abdomen/Pelvis, or T/L-Spine. Variable groupings strongly predictive of injury were tested to identify models with high sensitivity and a negative predictive value. ResultsWe included 608 patients. Median age was 77 y (interquartile range, 70-84.5) and 55% were male. Ground-level fall was the most common injury mechanism. The most commonly injured CT body regions were Head (52%) and Chest (42%). Variable groupings predictive of injury were identified in all body regions. We identified models with 97.8% sensitivity for Head and 98.8% for Face injuries. Sensitivities more than 90% were reached for all except C-Spine and Abdomen/Pelvis. ConclusionsDecision aids to guide imaging for older trauma patients are needed to improve consistency and quality of care. We have identified groupings of clinical variables that are predictive of injury to guide CT imaging after geriatric blunt trauma. Further study is needed to refine and validate these models.

A Prospective Randomized Study Comparing Functional Outcome in Distal Fibula Fractures between Conventional AO Semitubular Plating and Minimal Invasive Intramedullary “Photodynamic Bone Stabilisation”

(1) Background: As age in western populations is rising, so too are fractures, e.g., of the distal fibula. The aim of this study was to find out whether a novel, minimally invasive intramedullary osteosynthesis technique for the treatment of distal fibula fractures in elderly patients results in not only a reduction of postoperative complications, but also a shorter hospitalization time, an improved clinical outcome, and preserved autonomy in geriatric trauma patients. (2) Methods: In this prospective study, the results following surgical treatment for distal fibula fractures in geriatric patients after using DePuy Synthes® one-third semitubular plate (Group I) or a minimally invasive intramedullary photodynamic Bone StabilizationSystem (IlluminOss®) (Group II) were compared at 6 weeks, 12 weeks, 6 months, and 1 year after initial treatment. (3) Results: Significant improvement regarding clinical outcome was shown in Group II 6 and 12 weeks after surgery. (4) Conclusions: Our study results demonstrate that the use of this new intramedullary stabilization system in combination with an immediate postoperative weight bearing seems to be a safe and stable treatment option for ankle fractures in geriatric patients, especially in the early stages of recovery.

Dysphagia is associated with worse clinical outcomes in geriatric trauma patients

IntroductionDysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma...

Multidisciplinary Care Pathway Improves Outcomes in Geriatric Trauma Patients

According to this study: Implementation of a multidisciplinary geriatric clinical pathway for people who have traumatic injury led to substantial improvement in delirium and other clinical outcomes.

Case volume and rate are associated with outcomes in geriatric trauma: A case for geriatric trauma centers?

Increased morbidity and mortality in geriatric trauma patients are usually due to decreased physiologic reserve and increased comorbidities. It is unclear whether geriatric trauma case volume and rates correlate with survival. We hypothesized that geriatric patients would have increased survival when treated in high-case volume and rate trauma centers. A retrospective cohort study was conducted using the Trauma Quality Improvement Program database between 2015 and 2019. Geriatric trauma patients (≥65 years) with severe injury (Injury Severity Score ≥16) were included. Geriatric case volume (GCV) was defined as the mean annual number of treated geriatric trauma patients, while geriatric case rate (GCR) was the mean annual number of elderly trauma patients divided by all trauma patients in each center. Trauma centers were classified into low-, medium-, and high-volume and rate facilities based on GCV and GCR. The association of GCV and GCR with in-hospital mortality and complication rates was assessed using the generalized additive model (GAM) and multivariate generalized linear mixed model adjusted for patient characteristics (age, sex, Injury Severity Score, Revised Trauma Score, and Modified Frailty Index) as fixed-effect variables and hospital characteristics as random effect variables. A total of 164,818 geriatric trauma patients from 812 hospitals were included in the analysis. The GAM plots showed that the adjusted odds of in-hospital mortality decreased as GCV and the GCR increased. The generalized linear mixed model revealed that both high GCV and high GCR hospitals had lower mortality rates than low GCV and GCR hospitals (adjusted odds ratio [95% confidence interval], high GCV and high GCR centers; 0.82 [0.72-0.92] and 0.81 [0.73-0.90], respectively). Both high geriatric trauma volume and rates were associated with decreased mortality of geriatric trauma patients. Consolidation of care for elderly patients with severe injury in specialized high-volume centers may be considered. Therapeutic/Care Management; Level III.

All about the Benjamins: Efficacy of a modified triage protocol for trauma activation in geriatric patients

BackgroundThe geriatric triage protocol at the study institution was modified from SBP <90 mmHg to SBP <110 mmHg and then to SBP <100 mmHg. The purpose of this study is to evaluate the impact of adjusting geriatric triage protocols on patient outcomes. MethodsA single-center retrospective review was conducted on trauma patients 65 years or older. Three study periods with different geriatric specific trauma team activation (TTA) protocols (Group 1-SBP<90 mmHg; Group 2-SBP<110 mmHg; Group 3-SBP<100 mmHg) were compared. Results2016 patients were included. There were no differences in mortality rates or need for trauma intervention (NFTI) rates among the three groups. The SBP <100 mmHg and SBP <110 mmHg groups had similar under-triage rates. The NFTI over-triage rate in the SBP <100 mmHg group was lower than the SBP <110 mmHg group. ConclusionUsing SBP <100 mmHg threshold for TTA criteria in geriatric trauma patients improves over-triage without leading to under-triage.

Factors Predictive of Mortality among Geriatric Patients Sustaining Low-Energy Blunt Trauma.

In geriatric trauma patients, higher mortality rate is observed compared to younger patients. A significant portion of trauma sustained by this age group comes from low-energy mechanisms (fall from standing or sitting). We sought to investigate the outcome of these patients and identify factors associated with mortality. A retrospective review of 1285 geriatric trauma patients who came to our level 1 trauma center for trauma activation (hospital alert to mobilize surgical trauma service, emergency department trauma team, nursing, and ancillary staff for highest level of critical care) after sustaining low-energy blunt trauma over a 1-year period. IRB approval was obtained, data collected included demographics, vital signs, laboratory data, injuries sustained, length of stay and outcomes. Patients were divided into three age categories: 65-74, 75-84 and &gt;85. Comorbidities collected included a history of chronic renal failure, COPD, Hypertension and Myocardial Infarction. 1285 geriatric patients (age &gt; 65 years) presented to our level 1 trauma center for trauma activation with a low-energy blunt trauma during the study period; 34.8% of the patients were men, 20.5% had at least one comorbidity, and 89.6% were white. Median LOS was 5 days; 37 (2.9%) patients died. Age of 85 and over (OR 3.44 with 95% CI 1.01-11.7 and 2.85 with 95% CI 1.0-6.76, when compared to 65-74 and 75-84, respectively), injury severity score (ISS) (OR 1.08, 95% CI 1.02 to 1.15) and the presence of more than one comorbidity (OR 2.68, 95% CI 1.26 to 5.68) were independently predictive of death on multi-variable logistic regression analysis. Age more than 85 years, higher injury severity score and the presence of more than one comorbidity are independent predictors of mortality among geriatric patients presenting with low-energy blunt trauma.

Age as the Impact on Mortality Rate in Trauma Patients.

Globally, the fastest-growing population is that of older adults. Geriatric trauma patients pose a unique challenge to trauma teams because the aging process reduces their physiologic reserve. To date, no agreed-upon definition exists for the geriatric trauma patients, and the appropriate age cut point to consider patients at increased risk of mortality is unclear. To determine the age cut point at which age impacts the mortality rate in trauma patients in Thailand. This was a retrospective cohort and prognostic analysis study conducted in trauma patients ≥40 years. Patient data were retrieved from the trauma registry database and hospital information system in Songklanagarind Hospital. The estimated sample size of 1,509 patients was calculated based on the trauma registry data. The age with the maximum mortality rate was used as the cut point to define the elderly population. Hospital cost, intensive care unit (ICU) length of stay, gender, precomorbidity, mechanism of injury, injury severity score (ISS), and trauma and injury severity score were analyzed for any correlation with mortality, and whether or not they were associated with elderly trauma patients. A total of 1,523 trauma patients ≥40 years were included in the study. The median age in both the survival and death groups was 61 years, with gender in both groups being similar (p value = 0.259). In the multivariate logistic regression analyses, the adjusted odds ratio (OR) showed that increasing age was significantly associated with mortality (OR = 1.05; 95% CI, 1.02-1.07; p value <0.001). In the age group of 70 to 79 years and >80 years, the odds of mortality were significantly increased (OR 3.29, 95% CI, 1.24-8.68; p value = 0.016 and OR 3.29, 95% CI, 1.27-12.24; p value = 0.018, respectively). Age is a significant risk factor for mortality in trauma patients. The mortality significantly increased at the age of 70 and higher.

Race Is an Independent Predictor of Length of Stay among Geriatric Trauma Patients

INTRODUCTION: The association of race and outcomes in trauma has been shown in certain injuries. We sought to evaluate the association of race and hospital length of stay among geriatric trauma patients. METHODS: This was a retrospective review of geriatric trauma patients admitted to our Level I trauma center from January 2018 to December 2019. After IRB approval was obtained, data collected included vital signs, demographics, Injury Severity Score, and length of stay. Race was categorized into 3 groups, white, Black, and other. Length of stay was categorized into 7 days or less and more than 7 days. Multivariable logistic regression analysis was performed for the association of race and length of stay, controlling for injury severity. RESULTS: A total of 2,670 geriatric (older than 65 years) trauma patients were admitted to the hospital during the study period. There were 2,355 (88.2%) white, 53 (1.9%) Black, and 262 (9.9%) other races. There were 64% women, the median Injury Severity Score was 6 (4, 9), and the mean age was 81 ± 8 years. The median length of stay was 5 (2, 7) days. Race was an independent predictor of length of stay (p = 0.019). Compared with white race, Black race was associated with staying in the hospital for longer than 7 days (odds ratio 2.06, p = 0.013), and “other” was not (odds ratio 1.24, p = 0.15). Injury Severity Score was also significantly associated with length of stay of more than 7 days (odds ratio 1.05, p ≤ 0.001). CONCLUSION: Race is associated with length of stay among geriatric trauma patients. Black race is an independent predictor of length of stay longer than 7 days.

Geriatric Trauma, Frailty, and American College of Surgeons Trauma Center Verification Level: Are There Any Correlations with Outcomes?

INTRODUCTION: Frailty is prevalent among the elderly and confers increased risk for adverse outcomes. We aimed to assess the effect of American College of Surgeons (ACS) trauma center verification level on outcomes among frail and nonfrail geriatric trauma patients. METHODS: We analyzed the 2017 to 2019 ACS-TQIP including geriatric (65 years or older) trauma patients who presented to ACS Level I, II, or III trauma centers. Patients who were transferred or had missing data on verification level and hospital discharge disposition were excluded. Modified frailty index was calculated. After stratification into frail and nonfrail, matching was performed. Outcomes were adverse discharge (rehabilitation/SNF) and mortality. RESULTS: We identified 286,054 patients, and 110,680 patients were matched (frail: 55,340; nonfrail: 55,340). Of these, 2.8% died, and 55% had adverse discharge. Geriatric patients had lower rates of adverse discharge in Level I and II centers compared with Level III centers (52.6%, 55.8%, 60.9%, p < 0.001) regardless of frailty and injury severity, and higher rates of mortality in Level I and II centers compared with Level III trauma centers (4.9%, 3.7%, 2.8%, p < 0.001) among the moderate-to-severely injured only. Frail patients were more likely to die and be discharged to rehabilitation/SNF (Table).ACS, American College of Surgeons; ISS, Injury Severity Score.CONCLUSION: Mortality is low regardless of injury severity for geriatric trauma patients managed at ACS trauma centers. More than half of geriatric trauma patients are discharged to rehabilitation/SNF. Higher-level centers have higher mortality but lower rates of adverse discharge, regardless of frailty status and injury severity, and Level III centers may be underperforming with regards to resource allocation. Higher-level centers may be prioritizing quality of life over survival. Further studies are required to explore the relationship between frailty, verification level, end-of-life decision making, and transfer practices.

Futility of Resuscitation among Geriatric Trauma Patients: Do We Need to Define When to Withdraw Care?

Introduction: Survival<10% has been described as the point where risks outweigh benefits for trauma patients, and where withdrawal-of-care may be considered. There is little to no data describing futility of resuscitation (FR) in geriatric trauma. Such data would inform withdrawal-of-care decision-making for injured geriatric patients and their families while reducing potentially inappropriate healthcare resource-use. Study aims to identify characteristics associated with FR among geriatric trauma patients. Methods: We analyzed the 2018 ACS-TQIP. We included all severely injured (ISS>15) geriatric trauma patients(≥65yrs). FR was. Patients were stratified into decades of age and resuscitative endpoints and intervention employed were identified. Outcome was FR (any intervention/endpoint that was associated with >90% mortality). Results: 46,339 patients were identified (65-75yrs: 42%; 75-85yrs: 40%; ≥85yrs: 18%). Mortality was 18%, ISS was 21[17-26], 57% male, and 85% blunt-injury. ED-thoracotomy among those >65yrs, and prehospital cardiac-arrest and REBOA among those >85yrs were associated with FR. Transfusion of >40U PRBC or FFP within 24hrs was associated with FR. 4-hour PRBC volumes associated with FR were: 65-75yrs:>30U; 75-85yrs:>27U; >85yrs:>21U. Increasing age was associated with increasing mortality among those who received emergency laparotomy or vasopressors, but did not reach FR. Lowest in-hospital SBP < 50mmHg was associated with FR among those>85yrs. Conclusion: ED-thoracotomy and transfusions >40U of product are futile in anyone over 65. REBOA is futile in anyone over 85. Resuscitation is futile in all super-elderly with prehospital cardiac arrest or an episode of profound hypotension. Further studies redefining FR among the geriatric trauma patient population to include lower mortality rates may be warranted.

Effect of Regional Anesthesia Timing on Association with Delirium among Geriatric Trauma Patients with Multiple Rib Fractures

INTRODUCTION: Rib fractures cause significant morbidity among geriatric trauma patients, and elderly patients are at increased risk for delirium. Regional anesthesia (RA) has been shown to reduce the need for deliriogenic pain medications. We hypothesized that early use of RA may be associated with decreased delirium among this patient population. METHODS: We performed a retrospective review at our Level I trauma center to identify patients with 2 or more rib fractures from 2018 to 2019. We collected demographics, regional anesthesia type/timing, and outcomes including all Confusion Assessment Method (CAM) assessments recorded for each patient throughout their hospitalization. We calculated percentage of CAM negativity for each hospitalization (percentage of CAM negativity = negative CAM assessments/total CAM assessments × 100). RESULTS: A total of 636 patients with more than 1 rib fracture were identified. A total of 323 patients were older than 60 years. A total of 81 (25.1%) underwent RA (46 epidurals, 26 erector spinae blocks, 7 serratus anterior blocks, and 2 paravertebral blocks), and 242 (74.9%) did not receive RA. Mean percentage of CAM negativity was higher among RA patients than non-RA patients (95.1% vs 91.3%, p = 0.04); however, subgroup analysis showed patients receiving RA after 36 hours of admission had no difference in percentage of CAM negativity compared with non-RA patients (90.2% vs 91.3%, p = 0.78; Figure). Timing of RA did not affect in-hospital mortality, overall length of stay, ICU length of stay, or ventilator days.Figure.: CAM, Confusion Assessment Method.CONCLUSION: Among elderly trauma patients with multiple rib fractures, regional anesthesia use is associated with decreased rates of delirium; however, this effect is lost when RA is initiated more than 36 hours after admission.

Venous Thromboembolism Chemoprophylaxis in Geriatric Trauma Patients with Isolated Severe Traumatic Brain Injury

Venous Thromboembolism Chemoprophylaxis in Geriatric Trauma Patients with Isolated Severe Traumatic Brain Injury

Fall Risk Identification Throughout the Continuum of Care for Elderly Trauma Patients: An Injury Prevention Initiative

IntroductionFalls are the second leading cause of trauma-related deaths worldwide. Identifying fall risk patients and initiating interventions reduces injuries and mortality, particularly in the elderly. The primary aim of this retrospective study was to identify missed opportunities for fall risk identification and intervention for geriatric trauma patients. Patients and methodsIn this retrospective observational cohort study, the trauma registry was queried to identify geriatric patients admitted for a fall over 36 months. The electronic medical record (EMR) was reviewed to evaluate patients’ fall risk in the 12 months prior to the index fall admission. The EMR was also queried for repeat falls within 12 months after discharge, and to determine if fall prevention education was provided at discharge. Results597 patients met inclusion criteria; 68.3% were female. 64.7% were at risk for falling in the year before admission. 2% had documented fall prevention education at discharge. 32% of patients fell again within a year of discharge and 19.4% were readmitted for a repeat fall. Patients at high risk for falls (on the Hester-Davis scale) were significantly more likely to be readmitted (p = 0.005) and expire within six months (p = 0.033) than moderate risk patients. Mortality at 12 months post-admission for all patients was 19.4%. ConclusionThis large study demonstrated that geriatric trauma patients admitted for a fall were already at risk for falling in the 12 months prior to admission. This is a novel finding that presents a substantial prevention opportunity for healthcare systems. Education and implementation of proven techniques to prevent falls as soon as at-risk patients are identified has the potential to change the course for a patient who may not only fall, but also fall again. This proactive approach could significantly impact the fall epidemic in our elderly population.

Emergency readmissions following geriatric ground-level falls: How does frailty factor in?

BackgroundGround-level falls (GLFs) in older adults are increasing as life expectancy increases, and more patients are being discharged to skilled nursing facilities (SNFs) for continuity of care. However, GLF patients are not a homogenous cohort, and the role of frailty remains to be assessed. Thus, the aim of this study is to examine the impact of frailty on the in-hospital and 30-day outcomes of GLF patients. Materials and MethodsThis is a cohort analysis from the Nationwide Readmissions Database 2017. Geriatric (age ≥65 years) trauma patients presenting following GLFs were identified and grouped based on their frailty status. The associations between frailty and 30-day mortality and emergency readmission were examined by multivariate regression analyses adjusting for patient demographics and injury characteristics. ResultsA total of 100,850 geriatric GLF patients were identified (frail: 41% vs. non-frail: 59%). Frail GLF patients were younger (81[74–87] vs. 83[76–89] years; p<0.001) and less severely injured–Injury Severity Score [ISS] (4[1–9] vs. 5[2–9]; p<0.001). Frail patients had a higher index mortality (2.9% vs. 1.9%; p<0.001) and higher 30-day readmissions (14.0% vs. 9.8%; p<0.001). Readmission mortality was also higher in the frail group (15.2% vs. 10.9%; p<0.001), with 75.2% of those patients readmitted from an SNF. On multivariate analysis, frailty was associated with 30-day mortality (OR 1.75; p<0.001) and 30-day readmission (OR 1.49; p<0.001). ConclusionFrail geriatric patients are at 75% higher odds of mortality and 49% higher odds of readmission following GLFs. Of those readmitted on an emergency basis, more than one in seven patients died, 75% of whom were readmitted from an SNF. This underscores the need for optimization plans that extend to the post-discharge period to reduce readmissions and subsequent high-impact consequences.

Appropriate Imaging for Geriatric Trauma.

Trauma is the leading cause of preventable death in the United States. Early detection of life-threatening injuries leads to improved survival. Computed tomography (CT) scanning has become the modality of choice for early detection of injuries in the stable patient. Some studies have associated selective imaging (Selective-CT) with equivalent outcomes compared to whole body imaging (Pan-CT) with lower costs and radiation exposure. Within the geriatric population, however, the utility of Pan-CT remains controversial. Therefore, the aim of this study was to determine if a difference exists between Selective-CT and Pan-CT imaging in the geriatric trauma patient. A retrospective analysis of Level 3 (G60) trauma activations presenting to our urban Level I trauma center between June 2016 and June 2019 was performed. Pan-CT was defined by ICD-10 codes indicating a head, cervical spine, chest, abdomen, and pelvis CT series. Patients with missing images and those who were transferred from other institutions were excluded. Logistic regression controlling for age, gender, injury type, severity, and Glasgow Coma Score was performed. A total of 1014 patients met inclusion criteria. Of these, 30.9% underwent Pan-CT (n = 314), 48.9% had Selective-CT (n = 497), and 20.2% received no CT imaging (n = 203). After logistic regression, no clinically significant variations in emergency department length of stay (LOS), hospital LOS, ICU LOS, ventilator days, discharge disposition, missed injury rate, or mortality rate were observed between imaging strategies. Pan-CT provides no clinically significant advantage over Selective-CT in the geriatric trauma patient.

The Association of Gender and Mortality in Geriatric Trauma Patients.

The association of gender with mortality in trauma remains a subject of debate. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of gender with mortality in a group of geriatric trauma patients presenting to an academic level 1 trauma center (trauma center designated by New York State capable of handling the most severe injuries and most complex cases). Methods: We performed a retrospective review of geriatric trauma patients who were admitted to our trauma center between January 2018 and December 2020. Data collected included vital signs, demographics, injury, and clinical characteristics, laboratory data and outcome measures. The study controlled for co-morbidities, injury severity score (ISS), and systolic blood pressure (SBP) in the ED. Multivariable logistic regression analysis was performed to evaluate the association of gender and mortality. Results: 4432 geriatric patients were admitted during the study period, there were 1635 (36.9%) men and 3859 (87.2%) were White with an average age of 81 ± 8.5 years. The mean ISS was 6.7 ± 5.4 and average length of stay was 6 ± 6.3 days. There were 165 deaths. Male gender (OR 1.94, 95% CI 1.38 to 2.73), ISS (OR 1.12, 95% CI 1.09 to 1.14), Emergency Department SBP less than 90 mmHg (OR 6.17, 95% CI 3.17 to 12.01), and having more than one co-morbidity (OR 2.28, 95% CI 1.55 to 3.35) were independently predictive of death on multivariable logistic regression analysis. Conclusion: Male gender, Emergency Department systolic blood pressure less than 90 mmHg, having more than one co-morbidity, and injury severity are independent predictors of mortality among geriatric trauma patients.