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Timing of Presentation and the Impact of the Timing Upon Mortality of Critically Injured Geriatric Trauma Patients
*Tom Herron, *Daithi S Heffernan, *Sean F Monaghan, *Michael D Connolly, *Shea C Gregg, *Andrew Steven, *Charles A. Adams, William G. Cioffi
Brown University/ Rhode Island Hospital, Providence, RI

Objective: Trauma in the geriatric population is a growing problem as the US population continues to age. Trauma is the 5th leading cause of death in geriatric patients and many of these patients require care in trauma Intensive Care Units (TICUs). Data from medical ICUs indicate higher mortality for Geriatric patients admitted during night time hours; however no data exists about a potential night time effect on mortality in Geriatric trauma patients.
Design: 5 year retrospective chart review
Setting: Level 1 Trauma Center
Patients: Geriatric (>/=65 years old) trauma patients. Night time admission was defined as 10pm to 6am and weekend as Fri/Sat/Sun.
Interventions: None
Main Outcome Measures: ICU utilization, overall mortality, and mortality stratified by time, day and mechanism.
Results: 2,538 Geriatric trauma patients were admitted and most of these admissions occurred during the daytime (81%), and weekdays (57%). Nighttime versus daytime was associated with increased rates of “Fall” as mechanism (83.3%) Need for ICU admission was independent of time or day of presentation for geriatric patients. Geriatric Nighttime ICU admission was not associated with a difference in Injury Severity Score (ISS) (17 vs 18; p=0.8), overall mortality (13% vs 12%; p=0.6), or mortality following “Falls” 30.5% vs 26.8%; p=0.52)
Conclusions: Geriatric trauma victims admitted to the TICU are typically admitted during the daytime and weekday hours secondary to a fall. Unlike patients admitted to medical ICUs, mortality of patients admitted to TICUs is not affected by the time of day of admission or day of week. The presence of critical care trained trauma surgeons 24 hours a day may explain the differences in mortality between TICU & MICU admission in geriatric patients.

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