title: Minor injuries in older adults have different characteristics, injury patterns, and outcomes when compared with younger adults: an emergency department correlation study.
abstract: OBJECTIVE
  To examine the injury patterns, characteristics, and outcomes of older adults presenting with minor injuries compared with younger adults.
  
  
  BACKGROUND
  Sustaining a minor injury is one of the most common reasons people present to an Emergency Department. Many presentations involve older Australians and greater than 50% of older adults are discharged from the Emergency Department. However, little is known about the characteristics, injury patterns, and outcomes of minor injuries in older adults compared to younger adults.
  
  
  METHODS
  A 12-month exploratory correlational study was conducted using Emergency Department electronic medical record data from a single metropolitan hospital located in Sydney, Australia. Older adults were defined as ≥65 years with younger adults defined as 18-64 years. Minor injuries were classified by diagnoses as fractures/dislocations, sprains/strains, wounds/burns/infections, minor head injuries, eye/ear/nose/oral injuries. Exclusion criteria included: triage category 1 or 2, major trauma, critical care admission, or injuries and fractures to the hip or neck of femur.
  
  
  RESULTS
  There were 36,671 Emergency Department presentations of which 7582 (21%) were for older adults and 19,234 (52%) were younger adults (aged 18-64). Injuries represented 21% (n = 7754) of all Emergency Department presentations with 1294 (17%) occurring in those aged 65 years and older and 3937 (20%) in younger adults. Of the minor injuries (n = 3594; 10%), the most common presentation in younger adults was sprains/strains (n = 1045; 36%) but in older adults it was fractures (n = 229; 32%). There was a statistical (Pearson's χ(2) test 63.4, df = 4, P < 0.001) difference with injury pattern when comparing age groups. Older adults were allocated proportionately higher triage categories when compared with younger adults (Pearson's χ(2) test 26.3, df = 2, P < 0.001). Older adults with minor injuries had a longer mean stay (315 min; SD 238.9 min; younger adults 198 min, SD 132.3 min) and this difference was statistically (P ≤ 0.001) and clinically significant. Fewer older adults were discharged home (n = 531, 73%; n = 2648, 92%; P < 0.001) and more were admitted for minor injuries (n = 179, 25%; n = 156, 5%; P < 0.001) when compared with younger adults.
  
  
  CONCLUSIONS
  Older adults with minor injuries have different injury patterns, higher acuity, longer length of stay, and lower discharge rates compared with younger adults. Clinicians may need to modify their approach and differential diagnoses when treating older adults with minor injuries. Further research is needed to explore the reasons for these differences and whether older adults have different service needs compared with younger adults with minor injuries.
authors.affiliation: Emergency Department, Canterbury Hospital, Sydney Local Health District, Australia; University of Sydney, Sydney Nursing School, Australia. Electronic address: matthew.lutze@sswahs.nsw.gov.au.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lutze
authors.affiliation: University of Sydney, Sydney Nursing School, Australia; Director of Research and Practice Development, Northern Sydney Local Health District, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fry
authors.affiliation: Charles Perkins Centre and Sydney Nursing School, University of Sydney, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Gallagher
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D013223:Statistics as Topic; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: Emergency Department; Epidemiology; Fast track; Geriatrics; Hospital discharge; Minor injuries; Minor trauma; Older persons; Outcomes; Representations