Objectives
Fractures in older adults are a commonly diagnosed injury in the Emergency Department (ED). We performed a retrospective chart review to determine the rate of return to the same ED within 72 hours (returns) and the risk factors associated with returning.
Methods
Retrospective chart review study of patients ≥65 years old discharged from a large, academic ED with a new diagnosis of upper extremity, lower extremity, or rib fractures. Risk factors analyzed included demographic data, type of fracture, analgesic prescriptions, assistive devices provided, other concurrent injuries, and comorbidities (Charlson Comorbidity index). Our primary outcome was return to the ED within 72 hours.
Results
Three hundred fifteen patients qualified. The majority of fractures were in the upper extremity (64% [95% CI 58-69%]). Twenty patients (6.3% [95% CI 3.9-9.6%]) returned within 72 hours. The majority of returns (15/20, 75%) were for reasons associated with the fracture itself, such as cast problems and inadequate pain control. Only three patients returned for cardiac etiologies (<1% of all patients). Patients with distal forearm fractures had higher return rates (10.7% vs 4.5%, p 0.03) and most commonly returned for cast or splint problems. Age, gender, other injuries, assistive devices, and Charlson Comorbidity Index score (median 1, [IQR 1-2] for both groups) did not predict 72-hour returns.
Conclusion
Older adults with distal forearm fractures may have more unscheduled healthcare usage in the first three days after fracture diagnosis than older adults with other fracture types. Overall, revisits for cardiac reasons or repeat falls were rare (<1%).