Low falls and inpatient complications increase risk for longer length of stay in older persons admitted following trauma.

Abstract

Background: Older adults make up 33% of all trauma admissions in Australia despite comprising 17% of the population with rates rising faster for older age groups compared to any other age group. A high proportion of older adults admitted to hospital following trauma are frail and have increased rates of hospital acquired complications, resulting in poorer outcomes as well as increased resource utilisation and cost to the healthcare system. Length of Stay (LOS) is an important outcome for hospitals, contributing to resource utilisation and patient flow. This study aimed to determine factors associated with the primary outcome of LOS in older persons admitted with trauma at a major trauma centre as targets for improvement.

Methods: Ethics approval was obtained to collect data on all adult trauma admissions ≥ 1 day in patients aged 65 years and over. Patients were included in the Trauma in older persons (TOPS) database if they otherwise met criteria for the pre-existing trauma registry maintained by the hospital's trauma service. Admissions between January 2022 and January 2023 were included. Univariable negative binomial regression identified variables associated with LOS with p-values ≤ 0.1 which were then included in a multivariable regression model. Significance was taken as p-value ≤ 0.05.

Results: 1250 admissions ≥ 1 day and alive at discharge were included in the primary analysis. The median LOS was 7 (4-13) days. In the multivariable model, delirium (Incidence Rate Ratio (IRR) = 1.41, 95%CI = 1.25-1.59), inpatient fall (IRR = 1.46, 95%CI = 1.15-1.86), pneumonia (IRR = 1.28, 95%CI = 1.08-1.53), thromboembolism (IRR = 1.43, 95%CI = 1.05-1.96), blood transfusion (IRR = 1.34, 95%CI = 1.17-1.53) and unplanned intensive care admission (IRR = 1.52, 95%CI = 1.08-2.14) were all associated with increased LOS. Low fall mechanism was high risk for longer LOS (IRR = 1.26, 95%CI = 1.11-1.43).

Conclusions: After controlling for available factors, inpatient complications and patients admitted following low falls were identified as high risk for increased LOS and may represent areas for targeted quality improvement for older adults admitted following trauma.