title: Multisystem geriatric trauma.
abstract: OBJECTIVE
  To analyze the demographics, hospital course, functional outcome, and reimbursement for elderly patients sustaining multisystem trauma.
  
  
  METHODS
  The Trauma Registry was searched for patients > or = 65 years old with an Injury Severity Score (ISS) > or = 10 admitted with multisystem trauma from January 1991 through December 1991. Hospital data were obtained from the Trauma Registry; reimbursement data from the business office; and complete follow-up (mean, 12 months) data by telephone survey for all patients.
  
  
  RESULTS
  Of the 1931 trauma patients admitted during the study period, 601 (31%) were > or = 65 years old and 94 (5%) met the study criteria. Of these 94 patients, 52 were women and 42 were men; their mean age was 79 years (range, 65-100). Falls (59%) and motor vehicle crashes (36%) were the predominant causes of injury; closed head injury (CHI) and fractures were the most frequent injuries. The mean ISS was 18 (range, 10-57), and hospital stay averaged 10 days. Intensive care unit admission was necessary for 37%, and 38% required surgical intervention. Factors associated with mortality included previous myocardial infarction, chronic renal insufficiency, ventilatory or inotropic support (or both), shock (systolic BP < or = 90 mm Hg) at admission, bradycardia (HR < or = 60 bpm) at admission, and severe CHI (Glasgow Coma Scale score < or = 8). Mortality was 23% (22 of the 94 patients); three quarters of the deaths occurred in the first 24 hours--most from severe CHI. At discharge, 53% of patients (38 of 72) went home and 36% (26 of 72) went to nursing homes. At a mean follow-up of 12 months, an additional seven patients had died, and three quarters of the patients were at home with an independent functional status. The percentage of reimbursement for care was two thirds of cost.
  
  
  CONCLUSIONS
  Mortality rates are high for elderly patients who sustain multisystem trauma. Most deaths occur within the first 24 hours, and most injuries are severe CHIs. More than half of survivors are discharged home, and most are independent at long-term follow-up. Reimbursement is not commensurate with the functional outcome achieved and the care provided.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN 55905.
authors.forename: S P
authors.initials: SP
authors.lastname: Zietlow
authors.forename: P J
authors.initials: PJ
authors.lastname: Capizzi
authors.forename: M P
authors.initials: MP
authors.lastname: Bannon
authors.forename: M B
authors.initials: MB
authors.lastname: Farnell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017281:Cost of Illness; D004185:Disability Evaluation; D005260:Female; D006291:Health Policy; D006770:Hospitals, Group Practice / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007349:Insurance, Health, Reimbursement; D007902:Length of Stay / Q000191:economics; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D009104:Multiple Trauma / Q000191:economics / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D016896:Treatment Outcome