Citation

Dingley SD, Bauerle WB, Ramirez C, Weber H, Wilde-Onia R, Szoke AM, Benton A, Frutiger D, Mira AE, Hoff W, Stawicki SP. J. Emerg. Trauma Shock 2022; 15(2): 93-98.

Copyright

(Copyright © 2022, INDO-US Emergency and Trauma Collaborative, Publisher Medknow Publications)

DOI

10.4103/jets.jets_19_22

PMID

35910314

PMCID

PMC9336643

Abstract

INTRODUCTION: Geriatric trauma patients (GTP) make up an increasing percentage of the overall trauma population. Due to frailty, GTP are at an increased risk of morbidity and readmission. Therefore, it is becoming increasingly important to prognosticate outcomes to assist with resource utilization. We hypothesized that the "Identification of Seniors at Risk" (ISAR) score may correlate with both clinical outcomes and resource utilization for geriatric trauma patients.

METHODS: Patients older than 65 years who were admitted to the trauma service were screened using an ISAR scoring algorithm. Outcomes, including 30-day mortality, all-cause morbidity, hospital length of stay (LOS), intensive care unit (ICU) LOS, functional independence measures (FIM) at discharge, and percent discharged to a facility, were analyzed. Both descriptive and data-appropriate parametric and non-parametric statistical approaches were utilized, with significance set at α = 0.05.

RESULTS: One thousand and two hundred seventeen GTP were included in this study. The average age was 81, median injury severity score was 9, and 99% had a blunt trauma mechanism. ISAR scores were generally associated with increasing 30-day mortality (0%, 1.9%, 2.4%, and 2.1% for ISAR 0, ISAR 1-2, ISAR 3-4, and ISAR 5-6, respectively), morbidity (2.6%, 7.6%, 14.7%, and 7.3% for respective categories), longer hospital (3.1, 4.6, 5.1, and 4.3 days, respectively) and ICU stays (0.37, 0.64, 0.81, and 0.67, respectively), lower FIM score at discharge (18.5, 17.1, 15.8, and 14.4, for respective categories), as well as increasing percentage of patients discharged to a facility (29.8%, 58.9%, 72.1%, and 78.8% for respective categories).

CONCLUSIONS: This exploratory study provides important early insight into potential relationships between ISAR and geriatric trauma outcomes. ISAR screening is a quick and easy-to-use tool that may be useful in GTP triage, level-of-care determination, and disposition planning. Understanding populations at risk, especially those with more intricate discharge needs, is an important step in mitigating those risks and implementing appropriate care plans.

Language: en

Keywords

risk assessment; frailty; geriatric trauma; Clinical outcomes; functional independence measure; identification of seniors at risk