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Prediction of discharge location in elderly women after traumatic injury.
*Brandon Colvin1, *Allison Wyman2, Timothy Emhoff1, *Heena Santry1, *Jon D Dorfman1
1UMass Memorial, Worcester, MA;2University of Massachusetts Medical School, Worcester, MA
Objective
Determine factors associated with discharge location for elderly women after trauma.
Design
Cohort.
Setting
University Hospital.
Patients
Women age 55+ enrolled locally in an international osteoporosis study and seen as a trauma activation at a Level 1 trauma center.
Interventions
N/A.
Main Outcome Measured
Discharge home.
Results
Of 5,091 women, 151 were seen at a Level 1 trauma center. The median age was 79 and the Injury Severity Score (ISS) was 9.0. The most frequent mechanism was fall. Head and extremity injuries were the most common injuries.
Twenty-seven women were discharged home while 124 women were discharged to rehabilitation /nursing facilities. ISS did not differ between the discharge groups. Femur fractures were the most common injury in the group discharged to rehabilitation and none were discharged home. Women with concussions /subdural hematomas were more likely to be discharged home. Women discharged home were significantly younger (median 64 versus 81 years old).
Univariate analysis of baseline activity from the osteoporosis study revealed statistically significant differences: women discharged home were less likely to report any limitation of moderate activity, lifting/carrying groceries, walking one hundred yards/several hundred yards /more than a mile. Other activity measures were not statistically different.
Only age remained significant in a logistic regression model predicting discharge home (OR 0.36 per additional 10 years, 95% CI 0.223 to 0.605). ISS, comorbidities and activity status were not significant.
Conclusions
While pre-injury activity status was associated with discharge location in the univariate analysis, only age remained significant in logistic regression modeling. Physical activity most likely deteriorates with age and may therefore primarily be a marker of the aging process.
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