Objective: Ground level falls in older patients now account for over 50% of trauma activations. Older patients who fall are a heterogeneous group of patients with underlying comorbidities. The optimal team to initially evaluate older patients after a fall is unknown. The objective of this study was to identify differences in Emergency Department (ED) evaluation and treatment in older patients after ground level falls.
Methods: his was a retrospective chart review from a single, level one trauma center. An ICD10 search identified all patients over 65 years of age presenting to the ED following a ground level fall from 07/01/2017 to 05/31/2018. Prisoners, transfer patients, and those with Glasgow Coma Scale (GCS) scores < 14 were excluded. Demographics, comorbidities, ED examination findings, diagnostic studies, and diagnoses were all abstracted following accepted chart review guidelines. Charleston comorbidity index (CCI) and injury severity score (ISS) were both calculated. Primary outcomes were admission to the hospital and obtaining an ED abdominal computed tomography (CT). Multivariate analyses were performed to identify the contribution of trauma team activation on the outcomes. Inter-rater reliability of data abstraction was measured using the kappa statistic
Results: A total of 250 patients (152, [61%] female) with a mean age of 80.4 ±8.8 years were included. The trauma team was activated in 117 (47%) cases. 157 (63%) were admitted and 81 (32%) underwent an ED abdominal CT. After controlling for patient age, CCI, GCS score, syncope, ISS, trauma activation was associated with admission, odds ratio = 2.64, 95% CI 1.39, 4.99. Similarly, trauma team activation was associated with ED abdominal CT scan, odds ratio = 3.30, 95% CI 1.51, 7.22. Inter-rater reliability was excellent with kappa values >0.8.
Conclusion: Evaluation by the trauma team is associated with hospital admission and ED abdominal CT scanning in elderly patients with ground level falls. Future work should identify indications for trauma team activation in elderly patients after ground level falls.