MULTISYSTEM GERIATRIC TRAUMA

Purpose: To analyze the demographics, hospital course, functional outc ome, and reimbursement for elderly patients sustaining multisystem tra uma. Methods: The Trauma Registry was searched for patients greater th an or equal to 65 years old with an Injury Severity Score (ISS) greate r than or equal to 10 admitted with multisystem trauma from January 19 91 through December 1991. Hospital data were obtained from the Trauma Registry; reimbursement data from the business office; and complete fo llow-up (mean, 12 months) data by telephone survey for all patients. R esults: Of the 1931 trauma patients admitted during the study period, 601 (31%) were greater than or equal to 65 years old and 94 (5%) met t he study criteria. Of these 94 patients, 52 were women and 42 were men ; their mean age was 79 years (range, 65-100). Falls (59%) and motor v ehicle crashes (36%) were the predominant causes of injury; closed hea d injury (CHI) and fractures were the most frequent injuries. The mean ISS was 18 (range, 10-57), and hospital stay averaged 10 days. Intens ive care unit admission was necessary for 37%, and 38% required surgic al intervention. Factors associated with mortality included previous m yocardial infarction, chronic renal insufficiency, ventilatory or inot ropic support (or both), shock (systolic BP less than or equal to 90 m m Hg) at admission, bradycardia (HR less than or equal to 60 bpm) at a dmission, and severe CHI (Glasgow Coma Scale score less than or equal to 8). Mortality was 23% (22 of the 94 patients); three quarters of th e deaths occurred in the first 24 hours-most from severe CHI. At disch arge, 53% of patients (38 of 72) went home and 36% (26 of 72) went to nursing homes. At a mean follow-up of 12 months, an additional seven p atients had died, and three quarters of the patients were at home with an independent functional status. The percentage of reimbursement for care was two thirds of cost. Conclusions: Mortality rates are high fo r elderly patients who sustain multisystem trauma. Most deaths occur w ithin the first 24 hours, and most injuries are severe CHIs. More than half of survivors are discharged home, and most are independent at lo ngterm follow-up. Reimbursement is not commensurate with the functiona l outcome achieved and the care provided.