Abstract
Purpose
Older trauma patients (65 years or older), who suffer minor or moderate injury for which immediate hospitalization is not strictly indicated, are often admitted to the hospital due to a self-sufficiency problem. Although hospitalization is expensive and associated with risks, little is known about the course of such a social admission. Therefore, the aim of this study was to clarify the course and outcome of social admissions.
Methods
A single centre retrospective cohort study was performed in a level II trauma centre. All hospitalized trauma patients aged 65 or older between 2015 and 2021 with an Abbreviated Injury Scale (AIS) code of 1 or 2 were included. The primary outcome was defined as the number of complications during admission (e.g. pneumonia, urinary tract infection, delirium, decubitus and, in-hospital mortality). Secondary outcomes were missed injury, length of stay, discharge location (home, with homecare or a skilled nursing facility), 30-day hospital return and 1-year mortality.
Results
Out of 2900 older hospitalized trauma patients, 563 (19.4%) were included. Complications occurred in 99 patients (17.6%), eight patients (1.4%) died during admission, and in 17 patients (3.0%) a previously missed injury was found during the admission. The median length of stay was 5 days [IQR 2.00–9.00] and of all independent living patients, 49.1% could be discharged to their homes. After discharge, 4.4% of the patients returned within 30 days and, a total of 17.6% of all patients died within one year after discharge.
Conclusions
One out of five older trauma patients presenting at the emergency department were admitted because of social reasons. Social admissions are lengthy and are accompanied by a considerable amount of complications.
Similar content being viewed by others
References
Samaras N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: A review. Ann Emerg Med. 2010;56(3):261–9. https://doi.org/10.1016/j.annemergmed.2010.04.015.
Andrew MK, Powell C. An Approach to ‘the social admission.’ Can J Gen Intern Med 2016; https://doi.org/10.22374/cjgim.v10i4.80
Chou MY, Chen LK. Social admissions of the elderly: More medical attention should be paid. J Clin Gerontol Geriatr. 2010;1(2):27–8. https://doi.org/10.1016/j.jcgg.2010.11.001.
van de Water W, van Loevezijn A, van den Bremer J. Meer noodbedden voor kwetsbare ouderen nodig. Med Contact (Bussum) 2016;18–21.
Rutschmann OT, Chevalley T, Zumwald C, Luthy C, Vermeulen B, Sarasin FP. Pitfalls in the emergency department triage of frail elderly patients without specific complaints. Swiss Med Wkly. 2005;135(9–10):145–50. https://doi.org/10.2005/09/smw-10888.
Ayoung-Chee PR, Rivara FP, Weiser T, Maier RV, Arbabi S. Beyond the hospital doors: Improving long-term outcomes for elderly trauma patients. J Trauma Acute Care Surg. 2015;78(4):837–43. https://doi.org/10.1097/TA.0000000000000567.
NSHN, “Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) Events Definitions” Centers Dis. Control Prev. 2022; 1–18.
Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The delirium observation screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17(1):31–50. https://doi.org/10.1891/rtnp.17.1.31.53169.
Doyle DJ, Hendrix JM, Garmon EH “American Society of Anesthesiologists Classification,” Treasure Island (FL), 2022.
Marquetand J, et al. Delirium in trauma patients a year prospective cohort study of 2026 patients. Eur J Trauma Emerg Surg. 2021. https://doi.org/10.1007/S00068-021-01603-5.
van Aert GJJ, et al. The yield of tertiary survey in patients admitted for observation after trauma. Eur J Trauma Emerg Surg. 2022;48(1):423–9. https://doi.org/10.1007/s00068-020-01473-3.
Keijzers GB, Giannakopoulos GF, Del Mar C, Bakker FC, Geeraedts MG. The effect of tertiary surveys on missed injuries in trauma: a systematic review. Scand J Trauma Resusc Emerg. 2012. https://doi.org/10.1186/1757-7241-20-77.
Thomson CB, Greaves I. Missed injury and the tertiary trauma survey. Injury. 2008;39(1):107–14. https://doi.org/10.1016/j.injury.2007.07.030.
Ouslander JG, Diaz S, Hain D, Tappen R. Frequency and diagnoses associated with 7- and 30-day readmission of skilled nursing facility patients to a nonteaching community hospital. J Am Med Dir Assoc. 2011;12(3):195–203. https://doi.org/10.1016/j.jamda.2010.02.015.
Kaufman EJ, Zebrowski AM, Holena DN, Loher P, Wiebe DJ, Carr BG. The short and the long of it: timing of mortality for older adults in a state trauma system. J Surg Res. 2021;268:17–24. https://doi.org/10.1016/j.jss.2021.06.042.
Davidson GH, Hamlat CA, Rivara FP, Koepsell TD, Jurkovich GJ, Arbabi S. Long-term survival of adult trauma patients. JAMA J Am Med Assoc. 2011;305(10):1001–7. https://doi.org/10.1001/jama.2011.259.
“StatLine - Overlevingskansen; geslacht, leeftijd.” [Online]. Available: https://opendata.cbs.nl/statline/#/CBS/nl/dataset/70701ned/table?fromstatweb. [Accessed: 27-Sep-2022].
Olufajo OA, et al. Integrating geriatric consults into routine care of older trauma patients: One-year experience of a level i trauma center. J Am Coll Surg. 2016;222(6):1029–35. https://doi.org/10.1016/j.jamcollsurg.2015.12.058.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest. Patients and the public were not involved in any way in this study.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
van Aert, G.J.J., Huijgen, D., Faes, M. et al. Social admissions in older trauma patients, not just a one night stay. Eur J Trauma Emerg Surg 49, 1271–1277 (2023). https://doi.org/10.1007/s00068-023-02229-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-023-02229-5