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

J Orthop Trauma. 2019 May;33(5):234-238. doi: 10.1097/BOT.0000000000001436.

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.

MeSH terms

  • Aged
  • Female
  • Follow-Up Studies
  • Geriatric Assessment / methods*
  • Humans
  • Male
  • Motor Activity / physiology*
  • Patient Reported Outcome Measures*
  • Prognosis
  • Recovery of Function*
  • Retrospective Studies
  • Trauma Severity Indices
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / physiopathology
  • Wounds and Injuries / rehabilitation*