title: Return to the ED and hospitalisation following minor injuries among older persons treated in the emergency department: predictors among independent seniors within 6 months.
abstract: BACKGROUND
  minor traumatic injuries among independent older people have received little attention to date, but increasingly the impact of such injuries is being recognised.
  
  
  OBJECTIVE
  we assessed the frequency and predictors of acute health care use, defined as return to the emergency department (ED) or hospitalisation.
  
  
  METHODS
  national multicentre prospective observational study.
  
  
  METHODS
  eight Canadian teaching EDs between April 2009 and April 2013.
  
  
  METHODS
  a total of 1,568 patients aged 65-100 years, independent in basic activities of daily living, discharged from ED following a minor traumatic injury.
  
  
  METHODS
  trained assessors measured baseline data including demographics, functional status, cognition, comorbidities, frailty and injury severity. We then conducted follow-up telephone interviews at 6 months to assess subsequent acute health care use. We used log-binomial regression analyses to identify predictors of acute health care use, and reported relative risks and 95% CIs.
  
  
  RESULTS
  participants' mean age was 77.0, 66.4% female, and their injuries included contusions (43.5%), lacerations (25.1%) and fractures (25.4%). The cumulative rate of acute health care use by 6 months post-injury was 21.5% (95% CI: 19.0-24.3%). The strongest predictors of acute health care use within 6 months were cognitive impairment, RR = 1.6 (95% IC: 1.2-2.1) and the mechanism of injury including pedestrian struck or recreational injuries, RR = 1.6 (95% CI 1.2-2.2).
  
  
  CONCLUSIONS
  among independent community living older persons with a minor injury, cognitive impairment and mechanism of injury were independent risk factors for acute healthcare use. Future studies should look at whether tailored discharge planning can reduce the need for acute health care use.
authors.affiliation: Department of Emergency Services and Scientist, Clinical Epidemiology Unit, Sunnybrook Research Institute, Toronto, Ontario, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Lee
authors.affiliation: Faculte de Medicine, Universite Laval, Quebec, Canada.
authors.forename: Marie-Josee
authors.initials: MJ
authors.lastname: Sirois
authors.affiliation: Faculte de Medicine, Universite Laval, Quebec, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perry
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Raoul
authors.initials: R
authors.lastname: Daoust
authors.affiliation: Division of Emergency Medicine, Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Griffith
authors.affiliation: Division of Emergency Medicine, Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.affiliation: Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.affiliation: Unite de Recherché en Traumatologie-urgence-soins Intensifs du Centre de Recherché FRQ-S du CHU-Quebec, Quebec, Canada.
authors.forename: Marcel
authors.initials: M
authors.lastname: Emond
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living; D008297:Male; D009017:Morbidity / Q000639:trends; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*
keywords: emergency department; injuries; outcomes; seniors; services