Functional outcomes in octogenarian trauma.
BACKGROUND
Outcome data on geriatric trauma patients (GTPs) (age >or= 65) focus on mortality and resource use. We examined mortality and outcome in GTPs and octogenarian trauma patients (OTPs) (age >or= 80). We hypothesized that OTPs would have worse functional outcomes than GTPs as defined by functional independence measurement (FIM) scales.


METHODS
Our study was a 13-year retrospective analysis of a statewide trauma database. Isolated hip fractures and intubation with Glasgow Coma Scale scores of 3 at admission were excluded. Demographic data, preexisting conditions, complications, discharge destination, mortality, and FIM were analyzed.


RESULTS
OTPs constituted 17742 (40.9%) of 43297 GTPs admitted to trauma centers. Falls (64.4%) and motor vehicle collisions (24.5%) were predominant. Average Injury Severity Score (ISS) was higher in GTPs (11.5 +/- 9.2 vs. 10.8 +/- 8.3, p = 0.001). Cardiac disease was the most common preexisting condition. Diabetes, obesity, and pulmonary disease were more common in GTPs than in OTPs (p = 0.001). Dementia, congestive heart failure, and hematologic disease were more common in OTPs than in GTPs (p = 0.001). Pulmonary and infectious complications were most common and occurred with equal frequency in OTPs and GTPs. Mortality rates were higher (10.0% vs. 6.6%, p = 0.001) for OTPs overall and when stratified into low (<10), moderate (11-20), and high (>20) ISS subgroups (p = 0.001). Discharge destination was most often home (53.3% vs. 28.8%, p = 0.001) or a rehabilitation facility (20.0% vs. 17.4%, p = 0.001) for GTPs versus OTPs. OTPs were discharged to skilled nursing facilities (37.2% vs. 14.9%, p = 0.001) far more often than GTPs. FIM at discharge was lower in all categories for OTPs. Modified dependence in locomotion and transfer was seen for OTPs but not GTPs overall and when stratified by ISS subgroups (p = 0.001). Some dependence in feeding was seen for OTPs but not GTPs with high injury severity (p = 0.001). Otherwise, feeding, expression, and social independence were preserved for both OTPs and GTPs.


CONCLUSIONS
Functional outcomes after blunt trauma are worse for OTPs; however, functional independence in feeding and social interaction are preserved in OTPs even with moderate injury severity.
Grossman
Michael
M
Department of Surgery, University of Pennsylvannia Health Systems, St Luke's Hospital and Health Network, Bethlehem, Pennsylvannia 18015, USA. grossmm@slhn.org
Scaff
David W
DW
Miller
Donna
D
Reed
James
J
Hoey
Brian
B
Anderson
Harry L
HL
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005853:Geriatrics; D006801:Humans; D007902:Length of Stay; D008297:Male; D010414:Pennsylvania; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000145:classification* / Q000401:mortality