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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

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



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.


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.


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.


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).


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.


Prognostic Level III.

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