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J Orthop Trauma. 2019 Jan 8. doi: 10.1097/BOT.0000000000001436. [Epub ahead of print]

Are geriatric patients who sustain high-energy traumatic injury likely to return to functional independence?

Author information

1
University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201.
2
Department of epidemiology, Dartmouth Geisel School of Medicine, Hanover, NH.
3
Department of Orthopaedics, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD 21201.
4
Department of Orthopaedic Surgery, University of Arizona-Banner University Medical Center, PO Box 245064.
5
Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205.
6
Department of Orthopaedics, Dartmouth Hitchcock Medical Center, Lebanon, NH.

Abstract

OBJECTIVES:

To evaluate physical function and return to independence of geriatric trauma patients, to compare physical function outcomes of geriatric patients who sustained high-energy trauma with that of those who sustained low-energy trauma, and to identify predictors of physical function outcomes.

DESIGN:

Retrospective SETTING:: Urban Level I trauma center PATIENTS:: Study group of 216 patients with high-energy trauma and comparison group of 117 patients with low-energy trauma.

INTERVENTION:

Injury mechanism (high- versus low-energy mechanism) MAIN OUTCOME MEASUREMENT:: Patient Reported Outcome Measurement Information System (PROMIS) Physical Function patient reported outcome measure, and change in living situation and mobility.

RESULTS:

Physical function outcomes and return to independence differed between patients with high-energy and low-energy injuries. High-energy geriatric trauma patients had significantly higher PROMIS PF scores compared to low-energy geriatric trauma patients (PROMIS Physical Function score 42.2 ± 10.4 vs. 24.6 ± 10.4, p <0.001). High-energy geriatric trauma patients were able to ambulate outdoors without an assistive device in 67% of cases and were living independently 74% of the time in comparison to 28% and 45% of low-energy geriatric trauma patients respectively (p <0.001, p <0.001). Multivariate linear regression analysis demonstrated that low-energy mechanism injury was independently associated with a 13.2 point reduction in PROMIS Physical Function score (p < 0.001).

CONCLUSIONS:

Geriatric patients greater than one year out from sustaining a high-energy traumatic injury appear to be functioning within the expected range for their age while low-energy trauma patients appear to be functioning substantially worse than both age-adjusted norms and their high-energy cohorts.

LEVEL OF EVIDENCE:

Prognostic Level III.

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