title: The older they are the harder they fall: Injury patterns and outcomes by age after ground level falls.
abstract: BACKGROUND
  Trauma centers are seeing an increasing number of geriatric patients that are more susceptible to injuries even from relatively minor insults such as a ground level fall (GLF). As life expectancy increases, people are living in the geriatric age bracket for decades and often use anticoagulation agents for various comorbidities. We hypothesize that this patient population is not homogenous and we investigated the injury patterns and outcomes after GLF as a function of age and anticoagulation use. We also sought to identify injury patterns and patient characteristics of GLF patients.
  
  
  METHODS
  A retrospective review of a Level I trauma center's database identified all adult (age>18) trauma patients admitted after GLFs between 1/2003 and 12/2013. Demographics, injury patterns, antiplatelet use, anticoagulation use (including warfarin, enoxaparin, and rivaroxaban) and outcomes were abstracted.
  
  
  RESULTS
  The cohort included 5088 patients. 3990 patients were >60years and 38.2% were male. With each decade, although the mean ISS did not considerably change (range 7.0-8.6), mortality increased (0.9% at <60years vs. 5.5% at >90years), and the likelihood of home discharge decreased dramatically (73.7% at <60years vs. 18.2% at >90years). Abdominal solid organ injuries were rare (0.8%). Age was associated with an increased incidence of cervical spine (p=0.002), rib (p=0.009) and pelvic fractures (p<0.001). Only aspirin use was significantly associated with intracranial bleed (p=0.001). Aspirin (p=0.049) or warfarin (p<0.001) use was associated with increased overall mortality.
  
  
  CONCLUSIONS
  GLF patients are not homogenous as certain injury patterns change with increasing age. Aspirin use was associated with an increased incidence of intracranial bleeds, whereas other antiplatelet or anticoagulation agents were not. GLF is also associated with significant morbidity and mortality that increases dramatically with age. Both aspirin and warfarin are independently associated with increased mortality. These patient differences have implications for their evaluation and management.
  
  
  METHODS
  Epidemiological/prognostic study level IV.
authors.affiliation: Yale School of Medicine, Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, New Haven, CT 06510, United States. Electronic address: bishwajit.bhattacharya@yale.edu.
authors.forename: Bishwajit
authors.initials: B
authors.lastname: Bhattacharya
authors.affiliation: Yale School of Medicine, Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, New Haven, CT 06510, United States. Electronic address: adrian.maung@yale.edu.
authors.forename: Adrian
authors.initials: A
authors.lastname: Maung
authors.affiliation: Yale School of Medicine, Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, New Haven, CT 06510, United States. Electronic address: kevin.schuster@yale.edu.
authors.forename: Kevin
authors.initials: K
authors.lastname: Schuster
authors.affiliation: Yale School of Medicine, Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, New Haven, CT 06510, United States. Electronic address: kimberly.davis@yale.edu.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Davis
mesh_terms: D000058:Accidental Falls / Q000401:mortality / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D020300:Intracranial Hemorrhages / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Geriatric; Ground level fall; Mortality; Outcome