Variation of Blunt Traumatic Injury with Age in Older Adults: Statewide Analysis 2011-14.
BACKGROUND
Traumatic injury is a leading cause of death and disability in adults ≥ 65 years old, but there are few epidemiological studies addressing this issue. The aim of this study was to assess how characteristics of blunt traumatic injuries in adults ≥ 65 vary by age.


METHODS
Using data from the a single-state trauma registry, this retrospective cohort study examined injured patients ≥ 65 admitted to all Level I and Level II trauma centers in Pennsylvania between 2011 and 2014 (n=38,562). Patients were stratified by age into three subgroups (age 65-74; 75-84; ≥85). We compared demographics, injury, and system-level across groups.


RESULTS
We found significant increases in the proportion of female gender, (48.6% vs. 58.7% vs. 67.7%), white race (89.1% vs. 92.6% vs. 94.6%), and non-Hispanic ethnicity (97.5% vs. 98.6% vs. 99.4%) across advancing age across age groups, respectively. As age increased, the proportion of falls (69.9% vs. 82.1% vs. 90.3%), in-hospital mortality (4.6% vs. 6.2% vs. 6.8%), and proportion of patients arriving to the hospital via ambulance also increased (73.6% vs. 75.8% vs. 81.1%), while median injury severity plateaued (9.0% all groups) and the proportion of Level I trauma alerts (10.6% vs. 8.2% vs. 6.7%) decreased. We found no trend between age and patient transfer status. The five most common diagnoses were vertebral fracture, rib fracture, head contusion, open head wound, and intracranial hemorrhage, with vertebral fracture and head contusion increasing with age, and rib fracture decreasing with age.


CONCLUSIONS
In a large cohort of older adults with trauma (n= 38,000), we found, with advancing age, a decrease in trauma alert level, despite an increase in mortality and a decrease in demographic diversity. This descriptive study provides a framework for future research on the relationship between age and blunt traumatic injury in older adults.
Perelman School of Medicine at the University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania.
Emily
E
Earl-Royal
Perelman School of Medicine at the University of Pennsylvania, Department of Emergency Medicine, Philadelphia, Pennsylvania; University of Pennsylvania, Center for Public Health Initiatives, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Frances
F
Shofer
University of Pennsylvania, Center for Public Health Initiatives, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Dominique
D
Ruggieri
Perelman School of Medicine at the University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania; University of Pennsylvania, Center for Public Health Initiatives, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania.
Rosemary
R
Frasso
Perelman School of Medicine at the University of Pennsylvania, Center for Clinical Epidemiology, and Biostatistics, Philadelphia, Pennsylvania; The Penn Injury Science Center at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania.
Daniel
D
Holena
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D014193:Trauma Centers / Q000639:trends; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*