title: Geriatric preinjury activities of daily living function is associated with glasgow coma score and discharge disposition: a retrospective, consecutive cohort study.
abstract: The primary objective was to evaluate the associations of the Injury Severity Score (ISS), age, Glasgow Coma Score (GCS), preexisting medical conditions (PEMC), and preinjury activities of daily living (ADL) Katz score with discharge disposition in surviving geriatric trauma patients.Data were obtained from the trauma registry. The preinjury Katz ADL score was prospectively ascertained.Of 184 consecutive surviving geriatric trauma patients with an ISS of 4 to 30, age was 80 ± 8 years and 75% fell. A PEMC was present in 93%. Preinjury ADL limitation occurred in 33%. The Katz score had inverse associations with the number of PEMCs (P< .01) and dementia (P < .01). Preinjury residence was home in 93% and nursing home in 7%. Katz scores by discharge disposition were as follows: home (36%) 5.5 ± 1; nursing home (15%) 3.6 ± 2; rehabilitation (44%) 5.6 ± 1; long-term acute care (5%) 4.0 ± 3 (P < .01). Nursing home/long-term acute care discharge was independently associated (P< .01) withlower Katz score, higher age, and lower discharge GCS; dementia and the number of PEMCs had P > .05. The discharge GCS was associated with the Katz score (P < .01), head injury score (P < .01), dementia (P < .01), and admission GCS (P < .01). The discharge GCS was independently associated (P < .01) with the Katz score and admission GCS. The admission GCS was associated with the Katz score (P = .02), ISS (P < .01), head injury score (P < .01), and dementia (P < .01). The admission GCS was independently associated (P < .05) with the Katz score and ISS.The majority of geriatric trauma survivors with an ISS of 4 to 30 are not discharged home. Lower preinjury ADL function is associated with the lower admission and discharge GCS and greater care needs at discharge. Dementia and the number of PEMCs are not independent predictors of discharge disposition.
authors.affiliation: Trauma/Critical Services (Dr Dunham, Ms Chance, Ms Hileman, Ms Flowers, and Dr Ransom) and Physical Rehabilitation Services (Dr Puet), Youngstown, Ohio.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Dunham
authors.forename: Elisha A
authors.initials: EA
authors.lastname: Chance
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Hileman
authors.forename: Laurie L
authors.initials: LL
authors.lastname: Flowers
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ransom
authors.forename: Terrance A
authors.initials: TA
authors.lastname: Puet
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010809:Physical Fitness / Q000502:physiology*; D012042:Registries; D012189:Retrospective Studies; D017741:Survivors; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*