Exploring trauma recidivism in an elderly cohort

As the population ages, trauma in the elderly is an increasingly recognized source of elderly morbidity. However, previous reviews on the topic provide only broad recommendations. The purpose of this study was to examine the elderly recidivist cohort at an urban trauma center for mechanisms of repeat injury.

The trauma registry at a major urban trauma center was queried to identify all patients aged 65 and older admitted from 1991-2010. Recidivist admissions were compared to nonrecidivist admissions. Demographics, mechanism of injury, injury location, length of stay, and mortality data were collected. Recidivists' mechanism of injury was compared with their initial mechanism of injury. Descriptive statistics, Student t-test, and a z-rank test of proportions were applied with significance set to P ≤ 0.05.

Between 1991 and 2010, 6476 patients aged 65+ were admitted, of which 79 (1.22%) were recidivists. Of these, 64 patients were aged 65 and older for both admissions. Most often, recidivists were male (70% versus 60%) and injured in penetrating trauma (17% versus 7.5%, P = 0.045). Recidivists trended towards more frequent injuries in bicycle collisions (3% versus 1.9%) and all-terrain vehicle (ATV)/motorcycle crashes (6.3% versus 1.7%), but were less likely to be hit by cars (49% versus 36%, P = 0.034). At least two thirds of recidivist patients injured in falls, ATV/motorcycle accidents, and stabbings had previously been injured by the same mechanism.

The overall recidivism rate in the elderly population is low. Nevertheless, recidivists were more susceptible to penetrating trauma, ATV/motorcycle collisions, and possibly bicycle accidents. These findings can help design counseling initiatives and injury prevention programs that target specific elderly trauma patients.