Jacques Lee1, Marie-Josee Sirois2, Lynne Moore2, Jeffrey Perry3, Raoul Daoust4, Lauren Griffith5, Andrew Worster5, Eddy Lang6, Marcel Emond7. 1. Department of Emergency Services and Scientist, Clinical Epidemiology Unit, Sunnybrook Research Institute, Toronto, Ontario, Canada. 2. Faculte de Medicine, Universite Laval, Quebec, Canada. 3. Ottawa Hospital Research Institute, Ottawa, Canada. 4. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. 5. Division of Emergency Medicine, Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. 6. Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 7. Unite de Recherché en Traumatologie-urgence-soins Intensifs du Centre de Recherché FRQ-S du CHU-Quebec, Quebec, Canada.
Abstract
BACKGROUND: minor traumatic injuries among independent older people have received little attention to date, but increasingly the impact of such injuries is being recognised. OBJECTIVES: we assessed the frequency and predictors of acute health care use, defined as return to the emergency department (ED) or hospitalisation. STUDY DESIGN: national multicentre prospective observational study. SETTING: eight Canadian teaching EDs between April 2009 and April 2013. PARTICIPANTS: a total of 1,568 patients aged 65-100 years, independent in basic activities of daily living, discharged from ED following a minor traumatic injury. METHODS: trained assessors measured baseline data including demographics, functional status, cognition, comorbidities, frailty and injury severity. We then conducted follow-up telephone interviews at 6 months to assess subsequent acute health care use. We used log-binomial regression analyses to identify predictors of acute health care use, and reported relative risks and 95% CIs. RESULTS: participants' mean age was 77.0, 66.4% female, and their injuries included contusions (43.5%), lacerations (25.1%) and fractures (25.4%). The cumulative rate of acute health care use by 6 months post-injury was 21.5% (95% CI: 19.0-24.3%). The strongest predictors of acute health care use within 6 months were cognitive impairment, RR = 1.6 (95% IC: 1.2-2.1) and the mechanism of injury including pedestrian struck or recreational injuries, RR = 1.6 (95% CI 1.2-2.2). CONCLUSIONS: among independent community living older persons with a minor injury, cognitive impairment and mechanism of injury were independent risk factors for acute healthcare use. Future studies should look at whether tailored discharge planning can reduce the need for acute health care use.
BACKGROUND: minor traumatic injuries among independent older people have received little attention to date, but increasingly the impact of such injuries is being recognised. OBJECTIVES: we assessed the frequency and predictors of acute health care use, defined as return to the emergency department (ED) or hospitalisation. STUDY DESIGN: national multicentre prospective observational study. SETTING: eight Canadian teaching EDs between April 2009 and April 2013. PARTICIPANTS: a total of 1,568 patients aged 65-100 years, independent in basic activities of daily living, discharged from ED following a minor traumatic injury. METHODS: trained assessors measured baseline data including demographics, functional status, cognition, comorbidities, frailty and injury severity. We then conducted follow-up telephone interviews at 6 months to assess subsequent acute health care use. We used log-binomial regression analyses to identify predictors of acute health care use, and reported relative risks and 95% CIs. RESULTS:participants' mean age was 77.0, 66.4% female, and their injuries included contusions (43.5%), lacerations (25.1%) and fractures (25.4%). The cumulative rate of acute health care use by 6 months post-injury was 21.5% (95% CI: 19.0-24.3%). The strongest predictors of acute health care use within 6 months were cognitive impairment, RR = 1.6 (95% IC: 1.2-2.1) and the mechanism of injury including pedestrian struck or recreational injuries, RR = 1.6 (95% CI 1.2-2.2). CONCLUSIONS: among independent community living older persons with a minor injury, cognitive impairment and mechanism of injury were independent risk factors for acute healthcare use. Future studies should look at whether tailored discharge planning can reduce the need for acute health care use.
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