Functional outcomes in octogenarian trauma.

BACKGROUND: Outcome data on geriatric trauma patients (GTPs) (age >or= 65) focus on mortality and resource use. We examined mortality and outcome in GTPs and octogenarian trauma patients (OTPs) (age >or= 80). We hypothesized that OTPs would have worse functional outcomes than GTPs as defined by functional independence measurement (FIM) scales. METHODS: Our study was a 13-year retrospective analysis of a statewide trauma database. Isolated hip fractures and intubation with Glasgow Coma Scale scores of 3 at admission were excluded. Demographic data, preexisting conditions, complications, discharge destination, mortality, and FIM were analyzed. RESULTS: OTPs constituted 17742 (40.9%) of 43297 GTPs admitted to trauma centers. Falls (64.4%) and motor vehicle collisions (24.5%) were predominant. Average Injury Severity Score (ISS) was higher in GTPs (11.5 +/- 9.2 vs. 10.8 +/- 8.3, p = 0.001). Cardiac disease was the most common preexisting condition. Diabetes, obesity, and pulmonary disease were more common in GTPs than in OTPs (p = 0.001). Dementia, congestive heart failure, and hematologic disease were more common in OTPs than in GTPs (p = 0.001). Pulmonary and infectious complications were most common and occurred with equal frequency in OTPs and GTPs. Mortality rates were higher (10.0% vs. 6.6%, p = 0.001) for OTPs overall and when stratified into low (<10), moderate (11-20), and high (>20) ISS subgroups (p = 0.001). Discharge destination was most often home (53.3% vs. 28.8%, p = 0.001) or a rehabilitation facility (20.0% vs. 17.4%, p = 0.001) for GTPs versus OTPs. OTPs were discharged to skilled nursing facilities (37.2% vs. 14.9%, p = 0.001) far more often than GTPs. FIM at discharge was lower in all categories for OTPs. Modified dependence in locomotion and transfer was seen for OTPs but not GTPs overall and when stratified by ISS subgroups (p = 0.001). Some dependence in feeding was seen for OTPs but not GTPs with high injury severity (p = 0.001). Otherwise, feeding, expression, and social independence were preserved for both OTPs and GTPs. CONCLUSION: Functional outcomes after blunt trauma are worse for OTPs; however, functional independence in feeding and social interaction are preserved in OTPs even with moderate injury severity.

When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma.

BACKGROUND: As the U.S. population ages, the number of geriatric trauma victims will continue to grow. Outcomes are known to be worse for these patients, in large part because of preexisting conditions (PECs). The specific impact of various PECs on outcome in geriatric trauma has not been well studied because of heterogeneous data sets and sample sizes. METHODS: We sought to define the impact of clinical variables and PECs on mortality in geriatric trauma by analyzing a large statewide trauma database. We defined geriatric trauma patients as those age > or = 65. Isolated hip fractures were excluded. We used multiple logistic regression to determine the effect of 21 different PECs on 30-day in-hospital mortality. RESULTS: Data were abstracted from 33,781 patient records. Overall mortality was 7.6%. For each 1-year increase in age beyond age 65, odds of dying after geriatric trauma increased by 6.8% (95% confidence interval, 6.1-7.5%). When presenting vital signs, Glasgow Coma Scale score, and ISS were controlled, PECs with the strongest effect on mortality were hepatic disease (odds ratio [OR], 5.1), renal disease (OR, 3.1), and cancer (OR, 1.8). Chronic steroid use increased the odds of death after geriatric trauma (OR, 1.6), whereas Coumadin therapy did not. CONCLUSION: Considered independently, these data are insufficient to allow withdrawal of care, but this information may be a useful component to help in guiding families faced with difficult decisions after geriatric trauma.