B. Bailey1, M. Bindra1, A. Muller1, A. Martin1, T. Deaner1, T. E. Wasser1, A. Ong1, C. Butts1, A. Sigal1 1Reading Hospital, West Reading, PA, USA
Introduction:
Potentially Inappropriate Medications (PIMs) are well described risk factors for traumatic events, primarily ground-level falls, in older patients. Based on the American Geriatric Society 2019 updated recommendations of medications to avoid, we analyzed the association of selected PIM therapeutic categories, as well as a separate analysis of medications with anticholinergic mechanism of action, on the prevalence of recurrent traumatic events in those over age 65. We hypothesized that the use of PIMs would be associated with an increased incidence of trauma recidivism.
Methods:
A retrospective chart review of from February 1, 2013 through August 1, 2018 of patients age ≥ 65 with a traumatic injury at a Level 1 Trauma center was performed. Traumatic events were defined as those injuries severe enough to require a trauma team activation or consultation in the Emergency Department as well as isolated extremity and hip fractures after a ground-level fall. A 1:1 propensity score matching (PSM) using age, sex, race, and Injury Severity Score was performed between patients with one trauma encounter and those with more than one trauma encounter. Discriminant function analysis was used to determine PIM categories most associated with recurrent traumatic events. Logistic regression was then performed incorporating PIM categories identified by discriminant function. We analyzed anticholinergics as a separate category, as the mechanism of action was common in many PIM categories. A p value < 0.05 was considered statistically significant.
Results:
PSM yielded a match of 5,271 patients in each group. In a univariate analysis, cardiac (C), antiplatelet or anticoagulant (AP/AC), psychiatric or neurologic (P/N), and anticholinergic (ACH) medications were each associated with recurrent traumatic events compared to the absence of these agents (83.3% vs 80.1%, 63.5% vs 58.6%, 46.3% vs 38.5%, and 20.2% vs 16.8%, respectively all p value of <0.001). In a logistic regression analysis, the increased risk of traumatic recidivism reached statistical significance for AP/AC, P/N and ACH groupings 18% (95% CI 8-28%, p < 0.001), 32% (95% CI 22-43%, p <0.001), and 14.3% (95% CI 3-27%, p < 0.01) respectively. For cardiac medications, the 10% increased association did not meet statistical significance (95% CI 9.9-22%, p = 0.087).
Conclusion:
Continued use of PIM is associated with an increased risk of geriatric trauma recidivism. We identified P/N and AP/AC categories and anticholinergic mechanism of action as associated with recurrent trauma in this population. Our data shows that prescribers should routinely perform medication reconciliation to minimize recurrent geriatric injury. When conducted in a shared decision-making manner, prescribers can now quantify for their patients the risks versus benefits of continuing these medications.