Trauma the Leading Cause of Geriatric Emergency Room Visits

SEPTEMBER 09, 2019
Kenny Walter
Xavier Dubucs, MD

Xavier Dubucs, MD

In recent years there has been an increase emergency department (ED) visits by geriatric patients, primarily due to trauma.

A team, led by Xavier Dubucs, MD, Pôle médecine d'urgence, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France, evaluated the temporal changes in the use of emergency department for traumatic injuries, while characterizing their trauma, and specifying the mode of transport to the emergency department according to their residence.

In a monocentric, retrospective study of geriatric patients at least 65 years old, the investigators gathered data from 20,741 patients admitted to the University Center Hospital Emergency Department for trauma between 2013-2017.

The mean age of the study’s population was 81.8 years old, with 57.3% of the patient’s community-living with family members, 24.5% nursing home residents, and 18.22% community-dwelling living alone.

The investigators found that 33.3% of nursing home residents were transferred during the weekend, while 28.04% of the community-dwelling individuals (P <.001) were transferred. They also found that 10% of the community-dwelling patients occurred late at night, whole 21.8% of the transfers of nursing home residents occurred late at night (P <.001).

The authors also learned that the primary cause of the visit was head trauma, which was found in 32% of the patients. They also found a significant number of visits caused by cutaneo-mucous wounds (28.7%) and limb fractures (25.9%).

The majority of nursing home residents—98.4%--were transferred by ambulance, while 70.1% of community-dwelling individuals were transferred by ambulance.

Overall, 36% of the 20,741 patients were hospitalized.

“In comparison with community-dwelling individuals, ED transfers of NH residents in the context of trauma-related emergency were higher during after-hour periods, lengths of stay at the ED were longer, and residents were admitted less to the in hospital,” the authors wrote.

In a separate 2018 study, Dubucs led a research group that found examined the organizational and geographical factors linked with emergency department transfers among older adults living in nursing homes.

In a retrospective analysis of 5926 residents from 175 nursing homes the investigators found that 18.9% of residents were transferred to an emergency department at least once during the previous year.

Using adjusted multiple linear regression models, they found that nursing homes in rural areas had a significantly lower emergency department transfer rate than the nursing homes in urban areas (95% CI, 10.15−2.16, P  = 0.003), with an absolute emergency department transfer rate of 16.4% in rural areas and 20.4% in urban areas.

Pharmacy for internal use was significantly associated with a lower transfer rate compared with the nursing homes with no pharmacy for internal use [11.9% (SD = 9.2); 19.1% (SD = 10.1), 95% CI,  16.33−3.09, P =.004] and the implementation of a personalized care project in nursing homes was significantly associated with a lower rate [18.6% (SD = 11.4), 22.4% (SD = 12.4), 95% CI, 11.67−.63, P = .03].
 
The study, “The Temporal Trend in the Transfer of Older Adults to the Emergency Department for Traumatic Injuries: A Retrospective Analysis According to Their Place of Residence,” was published online in The Journal of Post-Acute and Long-Term Care Medicine.

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