Who Is the Geriatric Trauma Patient? An Analysis of Patient Characteristics, Hospital Quality Measures, and Inpatient Cost

Abstract

Purpose: The purpose of this study was 2-fold: 1) to investigate the age-related frequency, demographics and distribution of the middle-aged and geriatric orthopedic trauma population and 2) to describe the age-related frequency and distribution of hospital quality measure outcomes and inpatient cost. Methods: All patients > 55 years of age who required orthopedic, trauma, or neurosurgery consults at 3 hospitals within an academic medical center from 2014 to 2017 were prospectively followed. On initial evaluation, each patient’s demographics, injury severity, and functional status were collected. Patients were grouped into low and high-energy mechanism cohorts and divided into 5 groups based on age. Hospital quality measures including length of stay, complications, discharge location, and cost of care was compared between age groups. Data were analyzed using ANOVA and Chi-square tests. Results: A total of 3965 patients were included in this study of which 3268 (82%) sustained low-energy trauma and 697 (18%) sustained high-energy trauma. With increasing age, more patients had more comorbidities, were less likely to be community ambulators, and more likely to use assistive devices (p < 0.05). Patients in older age groups had longer lengths of stay, more complications, were more likely to need ICU level care, and were less likely to be discharged home (p < 0.05). Rates of mortality were also greater in patients of more advanced age in both low and high-energy cohorts, and the calculated risk triage tool (STTGMA) score increased with each age bracket (p < 0.05). Total cost of care differed between age groups in the low-energy cohort (p = 0.003). Conclusion: This epidemiological study provides a clear picture of the frequency and distribution of demographic, physiologic characteristics, outcomes, and cost of care in a middle-aged and geriatric orthopedic trauma population as evaluated by the STTGMA risk tool. Risk profiling of geriatric trauma patients allows for the establishment of baseline norms.

Profile of Geriatric Trauma in a Developing Country

“…This was similar to a study in which the percentage of male patients decreased with age [4] and another work where the men were more frequent in the lower age group [14]. It is possible that more females may present with more orthopaedic trauma with increasing age than men, probably because of depleting hormones from menopause.…”

“…Early mobilisation is vital in reducing morbidities and mortalities, so timely surgical intervention should be emphasised when the patient is fit. Patients who lose even one activity of daily living following a traumatic incident are more likely to sustain additional trauma, require placement in a rehabilitation facility, and have higher mortality rates [4]. There is a tendency to increase complications when hospital admission is prolonged in elderly patients.…”

Can We Predict Length of Stay for CJR Patients Who Sustain a Displaced Femoral Neck Fracture?

“…The STTGMA is a validated risk assessment tool for inpatient mortality in patients aged 55 years and older who sustain orthopaedic trauma injuries. 19 20 23 24 27 Each patient's STTGMA score was calculated using their demographics, functional status, and injury details at time of admission ( Table 1 ). Patients were divided into risk quartiles based on STTGMA score.…”

“…The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated risk assessment tool used to predict inpatient mortality risk in orthopaedic trauma patients aged 55 years and older. [19][20][21][22][23][24][25][26] The original STTGMA tool was built to calculate a mortality risk score on arrival to the emergency department using easily available clinical data. These variables include patient's age, injury details (low-energy vs. high-energy mechanism of injury), Glasgow Coma Scale (GCS), and comorbidity profile based on the Charlson comorbidity index (CCI).…”

Crosswalk between Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status Score for Geriatric Trauma Assessment

“…These injuries commonly occur from falls, motor-vehicle crashes, and burn injuries [ 2 ], and approximately 80 percent of geriatric trauma cases are managed non-surgically [ 3 ]. Geriatric trauma patients, aged 55 years and older [ 4 ], are a unique trauma population that is at increased mortality risk compared to trauma patients less than 55 years old [ 5 , 6 , 7 , 8 , 9 ]. Multiple factors have been associated with increased geriatric trauma mortality risk, some of which include frailty [ 10 , 11 ], cognitive impairment [ 1 ], cardiovascular and pulmonary insufficiency [ 1 ], and poor injury triage [ 6 , 12 , 13 ].…”