L. Podolsky2, V. Polcz1,2, O. Sizar1, A. Farooq1,2, M. Bukur1, I. Puente1, R. Farrington1, M. Polcz2, C. Orbay2, F. Habib1 1Broward Health Medical Center,Trauma,Ft Lauderdale, FL, USA 2Florida International University,Surgery,Miami, FL, USA
Introduction:
Trends in incidence and outcomes of traumatic injury among the elderly (age 65-84) and the supra-elderly (age > 85) are unknown. This information has the potential to offer insight into informed trauma system planning and improve outcomes in this highly vulnerable population.
Methods:
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database was queried to identify patients with ICD codes for a traumatic injury. Data, stratified by age group was then abstracted for incidence, lengths of stay, charges, mortality and discharge status for patients for the period 1997-2012. The study period was divided into four periods of 4-years each. Statistical analysis was performed using the ANOVA, t test, and chi square test as appropriate. A p value of <0.05 was used to determine significance.
Results:
Over the 16-year study period, traumatic events in the elderly have increased by 6.8% (p=0.0005) and by 29% in the supra elderly (p<0.001). In contrast, admissions for injury decreased in both adults and children (6%, and 29.5% respectively, p=0.0005). A decrease in length of stay was seen with decrease from 6.0 to 5.2 days (p<0.0001) in the elderly and 6.2 to 5.0 days (p<0.0001) in the supra-elderly. Length of stay for adults on the other hand has increased from 4.83 to 5.1 (p=0.06). Pediatric patient in-hospital mortality has decreased significantly (p=0.001) with concurrent increases in discharge to home (p=0.003). Adult in-hospital mortality rates and discharges home have remained stable (p=0.83, p=0.24 respectively). Elderly patients have shown stable in-hospital mortality rates (p=0.149) with decreased discharges home (p=0.0003). The supra-elderly have shown the worst trend in outcomes, with significant increases in in-hospital mortality (p=0.0003) and significantly fewer patients being discharged home (p=0.0004). Costs have risen for patients of all age groups over the study period (p<0.0001).
Conclusion:
Geriatric trauma is rising at an exponential rate, with the elderly and supra-elderly patients forming an increasing proportion of the trauma population. These elderly and supra-elderly patients have been shown to have poorer outcomes, as demonstrated by in-hospital mortality and discharge status. Geriatric specific trauma programs are urgently needed to address this evolving epidemic.
