Trauma Research Nurse Texas Health Harris Methodist Ft. Worth Hospital Ft. Worth, Texas, United States
Purpose: : The geriatric population is increasing. In 2020, the population rose to 71 million and is expected to reach 83 million by 2050. Many geriatric patients lead an independent, active lifestyle, due to having their chronic diseases successfully controlled. The common factor among this group is the physiological changes that occur over time which leads to decreased stability and the increased tendency to fall. The most common mechanism of injury for blunt geriatric trauma seen in emergency departments (ED) worldwide is falls. Our aim was to describe characteristics of geriatric patients sustaining low-severity trauma arriving at our ED to elucidate population information.
Design: : The study design was a retrospective chart review of the institution's trauma registry and electronic medical records from May 1, 2021, to September 30, 2021. The study adhered to the STROBE standard and included IRB approval.
Setting:: The study setting was an 851-bed urban north Texas hospital with a 100-bed level II trauma ED with an annual emergency department census of 120,000 and a total of 18,000 annual trauma activations of which 6,000 patients qualify for placement into the trauma registry.
Sample:: .Low-severity trauma was defined physical injury not requiring immediate intervention to prevent degradation of status. Low-severity trauma included ground level falls not resulting in altered mental status, or head trauma if on anticoagulants; patients experiencing low-energy collisions without, rollover, ejection, prolonged extrication, death in the vehicle, crush injury to head, chest, or pelvis, open fractures, suspected neck injuries, or long proximal bone fractures; no high-energy impact or rapid deceleration, or any motorcycle or bicycle collisions or auto-pedestrian collisions. Inclusion criteria included: patients > 65 years who arrived as the ED after sustaining low-severity trauma. Method of arrival was classified as arriving through triage or by ambulance. Exclusions included: < 65 years of age; sustained high-risk trauma; had no traumatic mechanism; or deceased in the ED or during their hospital stay.
Methods: : The EMR extraction included the method of arrival, chief complaint, admission/discharge status and location, length of stay, admitting diagnosis, and mechanism of injury. Trauma registry extraction included: age/gender; type of fractures; place of injury. The demographic analyzation of the patient group included age, arrival method, chief complaint, place of injury location, discharge location, discharge diagnosis including fracture.
Results: : Total records analyzed were 2668. Patients arriving via ambulance was 1761 (734 admitted). Patients arriving through triage totaled 870 (163 admitted). All admitted patients (907) had a chief complaint of fall. Most admissions (578) ranged from 1-6 days. Of the 907 patients admitted, 768 fell at home or outside of home of which 424 were discharged to a skilled nursing facility. Of these, 314 had a fall-related fracture.
Implications:: The findings support the need for allocated resources in the ED to care for the elderly patients sustaining low-severity trauma. The patients most commonly arrive by ambulance, suggesting they are not easily mobile, and often sustain a life-altering fracture, requiring supportive care. Fall prevention outside of home is needed.
