Social admissions in older trauma patients, not just a one night stay

Older trauma patients (65 years or older), who suffer minor or moderate injury for which immediate hospitalization is not strictly indicated, are often admitted to the hospital due to a self-sufficiency problem. Although hospitalization is expensive and associated with risks, little is known about the course of such a social admission. Therefore, the aim of this study was to clarify the course and outcome of social admissions.

A single centre retrospective cohort study was performed in a level II trauma centre. All hospitalized trauma patients aged 65 or older between 2015 and 2021 with an Abbreviated Injury Scale (AIS) code of 1 or 2 were included. The primary outcome was defined as the number of complications during admission (e.g. pneumonia, urinary tract infection, delirium, decubitus and, in-hospital mortality). Secondary outcomes were missed injury, length of stay, discharge location (home, with homecare or a skilled nursing facility), 30-day hospital return and 1-year mortality.

Out of 2900 older hospitalized trauma patients, 563 (19.4%) were included. Complications occurred in 99 patients (17.6%), eight patients (1.4%) died during admission, and in 17 patients (3.0%) a previously missed injury was found during the admission. The median length of stay was 5 days [IQR 2.00-9.00] and of all independent living patients, 49.1% could be discharged to their homes. After discharge, 4.4% of the patients returned within 30 days and, a total of 17.6% of all patients died within one year after discharge.

One out of five older trauma patients presenting at the emergency department were admitted because of social reasons. Social admissions are lengthy and are accompanied by a considerable amount of complications.