Early risk stratification of mortality in the geriatric patients who are at high risk for bleeding and fall from a ground level: an analysis of the national data.

Abstract

Background: The purpose of the study is to identify the risk factors of mortality early in patients who have history of using of anticoagulants or coagulopathy and sustained a ground level fall (GLF).

Methods: The American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) dataset of the calendar year 2013 through 2016 was accessed for the study. All elderly patients ≥ 65 years old, who were taking an anticoagulant and suffered from a GLF, were included in the study. Other patient characteristics included: sex, race, initial systolic blood pressure (SBP), hypotension (SBP less than 110 mmHg), Injury Severity Score (ISS), Glasgow Coma Scale (GCS) Score, comorbidities such as hypertension (HTN), congestive heart failure (CHF), chronic renal failure (CRF), chronic pulmonary obstructive disease (COPD) and cirrhosis. Multivariable analysis was performed to develop the risk model.

Results: A total of 10,368 patients qualified for the study. Of this total, 788 (7.6%) patients died. The median [IQR] age of the patients was 80 [75-85] years. More than 90% of the patients were white. Fifty-four percent of the patients were female. Approximately 8% of the patients presented with hypotension at the time of hospital arrival. Multivariable analysis showed advanced age, male gender, high ISS, low GCS, presence of hypotension, CHF, CRF, COPD and cirrhosis were highly significant for odds of mortality.

Conclusions: Approximately 8% of the patients, who took an anticoagulant or had a history of coagulopathy and sustained a GLF, died. Certain demographics, higher injury severity and a few comorbidities were highly associated with in-hospital mortality.