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Are Geriatric Patients Who Sustain High-Energy Traumatic Injury Likely to Return to Functional Independence?

Shah, Jason, BS*; Titus, Alexander J., PhD; O'Toole, Robert V., MD; Sciadini, Marcus F., MD; Boulton, Christina, MD§; Castillo, Renan, PhD; Breazeale, Stephen, CRNP; Schoonover, Carrie, BA; Berger, Peter, BS; Gitajn, I. Leah, MD

Journal of Orthopaedic Trauma: May 2019 - Volume 33 - Issue 5 - p 234–238
doi: 10.1097/BOT.0000000000001436
Original Article
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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- vs. low-energy mechanism).

Main Outcome Measurement: Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) 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 with low-energy geriatric trauma patients (PROMIS PF 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 with 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 PF score (P < 0.001).

Conclusions: Geriatric patients greater than 1 year out from sustaining a high-energy traumatic injury seem to be functioning within the expected range for their age, whereas low-energy trauma patients seem to be functioning substantially worse than both age-adjusted norms and their high-energy cohorts.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

*University of Maryland School of Medicine, Baltimore, MD;

Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, NH;

Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD;

§Department of Orthopaedic Surgery, Banner University Medical Center, University of Arizona, Phoenix, AZ;

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and

Department of Orthopaedics, Dartmouth Hitchcock Medical Center, Lebanon, NH.

Reprints: Jason Shah, BS, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201 (e-mail: Jason.shah@som.umaryland.edu).

R. V. O'Toole currently receives payment from Smith & Nephew and from CoorsTek for consultancy not related to this study. M. F. Sciadini currently receives payment from Stryker Orthopaedics for consultancy outside the submitted work. The remaining authors report no conflict of interest.

Presented with preliminary data as poster at the annual meeting of Orthopaedic Trauma Association, October 5, 2016, National Harbor, MD.

Accepted December 28, 2018

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