L. J. Wallace2, W. V. Zambare2, S. E. Sanchez1, 2, T. A. Dechert1, 2, T. S. Brahmbhatt1, 2 1Boston Medical Center, Division Of Trauma, Acute Care Surgery & Surgical Critical Care, Boston, MA, USA 2Boston University, Boston, MA, USA
Introduction:
As the geriatric population increases in number, so does the incidence of geriatric trauma. Our urban, safety-net trauma center treats geriatric patients with healthcare needs influenced by their social determinants of health. This study aims to characterize penetrating trauma in this population.
Methods:
Data on demographics, injury characteristics, condition on admission, and clinical outcomes were collected on all patients ≥55 years old with penetrating injuries treated at our hospital between 2010 and 2019. We used descriptive statistics to summarize the demographic and clinical characteristics of this population and univariate analysis to test for associations between variables. Data was stratified by insurance type, intoxication status, and injury intent. Univariate analysis was performed using Pearson’s chi square and Fisher-Freeman-Halton tests as appropriate for categorical variables and one-way ANOVAs for numerical variables.
Results:
Among 101 patients, average age was 60.7 (±6.73) years and 83% were male. The racial/ethnic breakdown reflected the diversity of our population (49% Black, 27% White, 11% Hispanic). In most patients, injury severity score was below 16 (82%), length of stay was short (4.25±7.32 days), and discharge was to home (70%).
Analysis showed that the majority of patients had government-sponsored insurance (57%), and many patients were intoxicated on presentation to the hospital (44%). Patients with self-inflicted injuries mainly suffered from injuries to the head/neck (50%, p<0.001), had a longer length of stay than those assaulted (9.27±12.96 vs 2.76 ±3.97 days, p<0.001), and were more often discharged to mental health facilities (64%, p<0.001). Mortality was higher in patients with no insurance than government or private insurance (30% vs 3.4% vs 8.7%, p=0.004).
Conclusion:
Geriatric trauma patients are known to have worse outcomes than their younger counterparts. Though most patients had minor injuries and were discharged home in the studied population, these risks are exacerbated by socioeconomic variables such as insurance status and substance use disorders. Hospital stays were longer in patients with government insurance, and mortality was highest among the uninsured. Though patient outcomes did not appear to vary by intoxication status, intoxicated older adults were disproportionately impacted by penetrating traumatic injuries. Further work is needed to better understand these associations found by univariate analysis in a small study size. Self-inflicted penetrating traumatic injuries were redemonstrated as a substantial cause of morbidity and mortality with longer hospital stays. Due to the healthcare barriers faced by this population, geriatricians and trauma surgeons must be proactive and aggressive in their interventions to reduce traumatic injury and improve patient outcomes.