Clinical Acuity in the Emergency Department and Injury Severity Determine Hospital Admission of Older Patients with Low Energy Falls: Outcomes from a Prospective Feasibility Study

Valentin Clemens; Maximilian M Saller; Rupert Meller; Carl Neuerburg; Christian Kammerlander; Wolfgang Boecker; Matthias Klein; Vera Pedersen

doi:10.3390/jcm12093144

Clinical Acuity in the Emergency Department and Injury Severity Determine Hospital Admission of Older Patients with Low Energy Falls: Outcomes from a Prospective Feasibility Study

J Clin Med. 2023 Apr 27;12(9):3144. doi: 10.3390/jcm12093144.

Authors

Valentin Clemens¹, Maximilian M Saller¹, Rupert Meller², Carl Neuerburg¹, Christian Kammerlander³, Wolfgang Boecker¹, Matthias Klein^{4

5}, Vera Pedersen^{1

4}

Affiliations

¹ Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany.
² Department of Orthopedics and Trauma Surgery, Klinikum Dritter Orden, Menzinger Str. 44, 80638 Munich, Germany.
³ Trauma Hospital Styria, Goestinger Straße 24, 8020 Graz, Austria.
⁴ Emergency Department, University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany.
⁵ Department of Neurology, University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany.

Abstract

Background: Low energy falls (LEF) in older adults constitute a relevant cause for emergency department (ED) visits, hospital admission and in-hospital mortality. Patient-reported outcome measures containing information about patients' medical, mental and social health problems might support disposition and therapy decisions. We investigated the value of a tablet-based (self-)assessment in predicting hospital admission and in-hospital mortality.

Methods: Patients 65 years or older, consecutively presenting with LEF to our level I trauma center ED (from November 2020 to March 2021), were eligible for inclusion in this prospective observational study. The primary endpoint was hospital admission; secondary endpoints were in-hospital mortality and the use of the tablet for self-reported assessment. Multivariate logistic regression models were calculated to measure the association between clinical findings and endpoints.

Results: Of 618 eligible patients, 201 patients were included. The median age was 82 years (62.7% women). The hospital admission rate was 45.3% (110/201), with an in-hospital mortality rate of 3.6% (4/110). Polypharmacy (odds ratio (OR): 8.48; 95% confidence interval (95%CI) 1.21-59.37, p = 0.03), lower emergency severity index (ESI) scores (OR: 0.33; 95%CI 0.17-0.64, p = 0.001) and increasing injury severity score (ISS) (OR: 1.54; 95%CI 1.32-1.79, p < 0.001) were associated with hospital admission. The Charlson comorbidity index (CCI) was significantly associated with in-hospital mortality (OR: 2.60; 95%CI: 1.17-5.81, p = 0.03). Increasing age (OR: 0.94; 95%CI: 0.89-0.99, p = 0.03) and frailty (OR: 0.71; 95%CI: 0.51-0.99, p = 0.04) were associated with the incapability of tablet use.

Conclusions: The severity of fall-related injuries and the clinical acuity are easily accessible, relevant predictors for hospital admission. Tablet-based (self-)assessment may be feasible and acceptable during ED visits and might help facilitate comprehensive geriatric assessments during ED stay.

Keywords: Charlson comorbidity index; clinical frailty scale; emergency severity index; hospital admission; injury severity; low energy fall; older adult; tablet-based assessment.

Grants and funding

This research received no external funding.