E. Ludi1, E. Foianini2, J. Monasterio3, S. South1, M. Boeck4, M. Swaroop1 1Feinberg School Of Medicine – Northwestern University,Division Of Trauma And Critical Care,Chicago, IL, USA 2Clinica Foianini,General Surgery,Santa Cruz De La Sierra, SANTA CRUZ, Bolivia 3Gobierno Departamental Autónomo,Department Of Health,Santa Cruz De La Sierra, SANTA CRUZ, Bolivia 4University Of California – San Francisco,Division Of Trauma And Critical Care,San Francisco, CA, USA
Introduction: Worldwide, the population older than age 60 years is expected to double by 2050 and triple by 2100. Those greater than 80 years old are expected to triple by 2050 and increase by seven times in 2100. The aging population of Latin America is predicted to increase from 7.1% in 1990 to 12.5% by 2050. Research from high-income countries demonstrates that trauma in the geriatric population (GP) is associated with higher morbidity and mortality secondary to comorbid conditions and decreased physiologic reserve. Minimal research exists on the prevalence and mechanisms of injury in the GP in low- and middle- income countries (LMICs), and no studies exist in Latin American LMICs, such as Bolivia.
Methods: Patient data was collected in the Emergency Department (ED) of six hospitals in Santa Cruz, Bolivia participating in the Panamerican Trauma Society Trauma Registry from October 1, 2015 to July 31, 2018. Inclusion criteria were all patients presenting with trauma. Data were coded with Microsoft Excel and analyzed with SAS v9.4. Comparisons were made between the GP, age greater than 65 years, and the younger population (YP): ages 18-64 years.
Results: N=8,796 patients were entered in the trauma registry over the 34 month period. Age was recorded for N=7,912 (90.0%) of patients. Ten point one percent (N=797) of patients were aged 65 years or greater, and N=4,989 (63.1%) were aged 18-64 years. Among the GP, 43.7% were male, as opposed to 69.5% of the YP being male (p <0.0001). Only 0.04% of GP presented with alcohol involved in the trauma in contrast to 18.2% of the YP (p <0.0001). A large majority of the GP presented with falls (N=542, 69.8%) versus 1,638 (32.8%) in the YP (p < 0.0001). Motor vehicle crashes were the second most common in both populations representing N=64 geriatric injuries (8.0%) and N=886 (17.8%) YP injuries. The GP most commonly had isolated injuries of the pelvis or hip (21.9% vs. 1.9% of the YP, p <0.0001) and the upper extremity (21.8% vs 25.5% of the YP, p = 0.06). In contrast to the GP, the YP more commonly presented with polytrauma (YP 20.3% vs 11.6% of the GP, p<0.0001). Regarding ED disposition, the majority of patients were discharged home in both patient populations (GP 50.6% vs YP 58.0%, p=0.01), but the GP was more likely to be admitted to the hospital, 38.0% vs 26.8% (p<0.0001). There was no statistically significant difference in ICU admission (GP 1.03% vs YP 0.65%, p = 0.31) or mortality (GP 0.30% vs YP 0.29%, p=0.99).
Conclusion: As overall life expectancy improves, the number of geriatric patients presenting with trauma will increase. The geriatric trauma population in Bolivia is mostly female, who typically present after falls with isolated hip injuries, and more commonly require hospital admission as compared to their younger counterparts. Understanding how geriatric patient presentations differ compared to the YP can inform prevention methods, hospital resource distribution, and discharge planning.