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

Abstract

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.

National trends in extremity fracture hospitalizations among older adults between 2003 and 2017

“…Collectively, available evidence highlights the importance of emerging efforts to develop and scale evidence‐based treatment pathways and services that meet the diverse needs of older adults. For example, prior studies indicate that older adults with high energy injuries are younger, have fewer comorbidities, and despite the severity of their injuries, are more likely to be discharged home with significantly lower mortality and better physical function compared with older adults with low energy injuries who are more likely to be frail 12–16 . The effectiveness of treatment protocols that employ frailty screening 31–33 and comprehensive geriatric assessment, to guide perioperative and post‐operative care and improve outcomes merit attention.…”

“…For example, prior studies indicate that older adults with high energy injuries are younger, have fewer comorbidities, and despite the severity of their injuries, are more likely to be discharged home with significantly lower mortality and better physical function compared with older adults with low energy injuries who are more likely to be frail. [12][13][14][15][16] The effectiveness of treatment protocols that employ frailty screening [31][32][33] and comprehensive geriatric assessment, to guide perioperative and post-operative care and improve outcomes merit attention. Comprehensive geriatric assessment, while effective in some settings, may be difficult to implement in the trauma setting.…”

“…There is disagreement about what constitutes high energy injuries in older adults with some studies finding that injury profiles from low energy falls are commensurate with high energy injuries in young adults. 10,11 However, other studies have found that older adults with high energy injuries as traditionally defined have better outcomes compared with low energy injuries [12][13][14][15][16] suggesting that injury mechanism has important implications for acute and post-acute management. No studies have comprehensively examined trends or the composition of older adults' fracture hospitalization by injury mechanism.…”

Patient-Reported Outcome Measurement Information System (PROMIS) in Orthopaedic Trauma Research

“…PROMIS has also has been used to study injuries in geriatric patients ( Table 3 ) [ 30 , 31 ]. Alvarez-Nebreda et al revealed that PROMIS Physical Function scores of patients’ health care proxies were less accurate for frail patients [ 31 ] .…”

“… Author Year Study type and level of evidence # of patients PROMIS domain Study injury Other PROMs Conclusions Alvarez-Nebreda et al [ 31 ] 2019 Prospective cohort study, II 273 Physical function (CAT), pain interference (CAT) Geriatric trauma injury FRAIL PROMIS Physical Function scores completed by patients’ health care proxies were less accurate for frail patients. Shah et al [ 30 ] 2019 Retrospective cohort study, III 333 Physical function (CAT) Geriatric trauma injury Low-energy geriatric trauma patients had worse functional outcomes compared to the high-energy geriatric trauma patients after one or more years post-injury. Van Leeuwen et al [ 35 ] 2016 Retrospective cohort study, III 124 Physical function (CAT), pain intensity (SF) Any traumatic injury IEQ, PHQ-2, PSEQ-2, PCS-4 Race, employment status, cause of injury, and perception of self-efficacy are all risk factors for worse PROMIS Physical Function scores, while catastrophic thinking is a risk factor for worse PROMIS Pain Interference scores.…”