Geriatric trauma: outcomes of elderly patients discharged from the ED

This study was undertaken to investigate which patients 65 years of age or older have adverse outcomes after discharge from the emergency department (ED) after an injury. Patients were enrolled prospectively at an urban university center from September 15, 1996, until August 31, 1997. Patients sustaining any potentially serious form of injury were included. Data about comorbid conditions, preinjury medications, and types of injuries sustained were recorded. Patients were contacted at home at least 30 days after discharge and were questioned about their overall health, need for admission since ED discharge, and whether any complications developed. One hundred five consecutive patients were enrolled, but 5 patients were lost to follow-up. There were 74 low-mechanism falls (LMFs), 11 low-mechanism motor vehicle crashes (LMMVCs), 8 high-mechanism motor vehicle crashes (HMMVCs), 3 high-mechanism falls (HMFs), and 4 other types of injuries. Follow-up ranged from 30 to 147 days, with a mean of 49 days. On follow-up, 88 patients were doing well, 9 were fair, and 3 were doing poorly; of the latter, their poor health was unrelated to their injuries. Complications included 2 extremity infections and 1 poorly healing wound. Eleven patients were seen in an ED within the first 30 days after injury, 6 of whom for problems related to their initial injury or its management. These results show that there is a subset of elderly victims of trauma who may be safely discharged home after appropriate evaluation. Return visits to the ED were just as often related to comorbid conditions as to initial injury.