GERIATRIC EMERGENCY MEDICINE Emergenze-urgenze nel paziente anziano

Verona, 16-17 Maggio 2014

Trauma in senior adults evaluated in the Emergency Department: a retrospective study

L.Barutta1,2, E.Pizzolato1,2, E.Bernardi1,2, M.Bonetto1,2, P.Cosio1,2, P.Crida1,2, V.Olocco1,2, G.Racca1,2, C.Serraino1,2, E.Testa1,2, F.Tosello1,2, A.Allione1, B.Tartaglino1 1 Emergency Department, Santa Croce and Carle Hospital, Cuneo, Italy 2 School of Medicine, University of Turin, Italy

Purpose: Trauma is a common cause of admission to the Emergency Department (ED). Injuries are the eighth leading cause of death among senior adults (defined as people aged ≥65 years) in the United States with 2.7 million ED admissions for non-fatal injuries in 2001. In 2013, 77299 people were admitted to the ED of Santa Croce and Carle Hospital in Cuneo; 20024 (25.9%) were senior adults and 3238 (16.1%) of them came for traumatic events at any body site. The purpose of this study was to evaluate the demographical characteristics, treating strategies and outcome in terms of hospital admission.

Materials and methods: Patients aged ≥65 years admitted to our ED for trauma between January 2013 and December 2013 were included. 3238 digital medical records were retrospectively reviewed.

Results and discussion: 3238 patients were enrolled, 2077 (64.1%) women and 1161 (35.9%) men, 1225 (37.8%) aged 65-74 years (young old), 1251 (38.6%) 75-84 years (old old), 762 (23.5%) ≥85 years (oldest old). Sites of injury were limbs (55%), head (20.1%), thorax (10.5%), spinal column (9.2%), abdomen (0.2%), pelvis (0.4%), multiple sites (3.6%). 1359 (41.9%) traumas were associated with bone fracture respectively on limbs (1053, 32%), spinal column (168, 5.18%) and thorax (138, 4.26%). Femur was the most frequent fracture site (320, 23.5%), followed by humerus (147, 10.8%) and radio (143, 10.5%). Analgesic treatment was administered in 387 (12%) patients, respectively NSAIDs (192, 49.6%), steroids (11, 2.84%), opioids (181, 46.7%), propofol (3, 0.77%). 224 (16.5%, 57.8% of all treated patients) patients with bone fractures received NSAIDs in 100 cases (44.6%), steroids in 4 (1.78%), opioids in 117 (52.2%), propofol in 3 (1.33%). In treated patients, 154 subjects (39.7%, 12.5% of their age-class) were young old, 157 old old (40.5%, 12.5% of their age-class), 76 oldest old (19.6%, 9.9% of their age-class). Oligoanalgesia is less likely in patients presenting with bone fractures (OR 0.48, 95%CI 0.39-0.6) with more likely opioid use (OR 1.69, 95%CI 1.12-2.55); no significant differences were seen in terms of oligoanalgesia between age-classes (OR 1.3, 95%CI 0.99-1.69). After evaluation in the ED, 765 (23.6%) patients were hospitalized, 2450 (75.6%) discharged and 21 (0.64%) transferred to minor hospitals. Among bone fractures, 574 (42.2%) were hospitalized, 782 (57.5%) discharged and 3 (0.3%) transferred to minor hospitals. Hospitalization after trauma was significantly associated with bone fracture (OR 6.46, 95%CI 5.37-7.77).

Conclusions: Trauma is a leading cause of ED admission in the elderly and is often associated with bone fractures, with increased risk of hospitalization. Analgesia in the ED is an important but often underused therapeutic aid since old people do not experience and express pain acuity as young do. Emergency providers are sometimes unable to understand symptoms and potential adverse pharmacological effects and are frequently focused more on diagnosis than on therapy.

3238 patients: •2077 women, 1161 men; •122565-74y, 125175-84y, 762≥85y ; •Major sites of injury: limbs, head, thorax; •Most frequent fracture sites: femur, homerus, radio; •12% of patients received analgesic treatment.

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