QUANTIFYING THE IMPACT OF COMORBIDITIES ON LENGTH OF STAY IN GERIATRIC FALL-RELATED INJURIES

Objectives: Geriatric patients who fall are among the highest frequency mechanisms of injury treated at level one trauma centers. Previous work has identified age, injury severity score, and admission Glasgow Coma Scale (GCS) as significant predictors of length of stay (LOS) in trauma patients. We sought to quantify the impact of various comorbidities on LOS in geriatric patients who fall in an effort to identify areas for intervention.

Methods: The trauma registry of a single level one trauma center was queried for patients 65 years or older with a fall mechanism who were admitted with LOS greater than 2 days. Univariate analysis was used to summarize trends and identify differences between subgroups. Multivariate linear regression was employed to quantify the impact of comorbidities on LOS.

Results: Between 2013 and 2019, 3714 patients met inclusion criteria. Mean age was 80.9 +/- 8.7 years. All patients fell from heights of 6 feet or less. Median admission GCS was 15. Average Injury Severity Score (ISS) was 12.2 +/- 7.6. Median total LOS was 5 days, interquartile range (IQR) [3,8]. Just under one third of patients, 1118 (30.1%), spent time in the intensive care unit (ICU), with median ICU LOS 2 days, IQR [1,3]. Of these, 234 (6.3%) required ventilatory support, using a median of 3 ventilator days, IQR [1,7]. Overall mortality rate was 3.3%. The most common comorbidities were cardiovascular (2119, 57.1%), musculoskeletal (1166, 31.4%), diabetes (772, 20.8%) and neurological (581, 15.9%). Multivariate linear regression modeling of length of stay controlling for age, ISS, admission GCS and significant comorbidities is shown in Table 1. Diabetes, pulmonary, and psychiatric diseases significantly contributed to longer lengths of stay (p < 0.05).

Conclusion: Trauma patient comorbidities impact the average LOS. Diabetes, pulmonary, and psychiatric diseases significantly impact the length of stay in geriatric patients who sustain injuries from falls. As trauma center services are refined to treat geriatric trauma patients, comorbidity management represents an opportunity for proactive intervention and more efficient disposition planning.