title: Injuries and outcomes associated with traumatic falls in the elderly population on oral anticoagulant therapy.
abstract: BACKGROUND
  Fall risk for older adults is a multi-factorial public health problem as 90% of geriatric injuries are caused by traumatic falls. The CDC estimated 33% of adults >65 years incurred a fall in 2011, with 30% resulting in moderate injury. While much has been written about overall risk to trauma patients on oral anticoagulant (OAC) therapy, less has been reported on outcomes in the elderly trauma population. We used data from the National Trauma Data Bank (NTDB) to identify the types of injury and complications incurred, length of stay, and mortality associated with OACs in elderly patients sustaining a fall.
  
  
  METHODS
  Using standard NTDB practices, data were collected on elderly patients (≥65 years) on OACs with diagnosis of fall as the primary mechanism of injury from 2007 to 2010. Univariate analysis was used to determine patient variables influencing risk of fall on OACs. Odds ratios were calculated for types of injury sustained and post-trauma complications. Logistic regression was used to determine mortality associated with type of injury incurred.
  
  
  RESULTS
  Of 118,467 elderly patients sampled, OAC use was observed in 444. Predisposing risk factors for fall on OACs were >1 comorbidity (p<0.0001). Patients on OACs were 188% and 370% more likely to develop 2 and >3 complications (p<0.0001); the most significant being ARDS and ARF (p<0.0001). The mortality rate on OACs was 16%. Injuries to the GI tract, liver, spleen, and kidney (p<0.0002) were more likely to occur. However, if patients suffered a mortality, the most significant injuries were skull fractures and intracranial haemorrhage (p<0.0001).
  
  
  CONCLUSIONS
  Risks of anticoagulation in elderly trauma patients are complex. While OAC use is a predictor of 30-day mortality after fall, the injuries sustained are markedly different between the elderly who die and those who do not. As a result there is a greater need for healthcare providers to identify preventable and non-preventable risks factors indicative of falls in the anti-coagulated elderly patient.
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States. Electronic address: boltzm@ccf.org.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Boltz
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States. Electronic address: apodany@hmc.psu.edu.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Podany
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, United States. Electronic address: chollenbeak@psu.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States. Electronic address: sarmen@hmc.psu.edu.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Armen
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology / Q000401:mortality*; D000058:Accidental Falls / Q000401:mortality / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000401:mortality*; D041981:Gastrointestinal Tract / Q000293:injuries*; D006801:Humans; D015601:Injury Severity Score; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000401:mortality*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D011634:Public Health; D012307:Risk Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000401:mortality*; D014950:Wounds, Penetrating / Q000209:etiology / Q000401:mortality*
chemical_list: D000925:Anticoagulants
keywords: Elderly; Falls; Oral anticoagulation; Trauma