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• W1526183089 abstract "Trauma in the elderly, a physiologically fragile population, is an increasing challenge in an ageing population.1 Low-energy falls account for an expanding proportion of geriatric hospital admissions, with head injury and hip fracture as the two most common injuries.2 In the current issue of the journal,3 an inner city trauma centre has analysed its prospective trauma registry over 11 years for patients over 65 who sustained a fall less than 1 m. It has found that the burden of geriatric hip fracture has steadily decreased (n = 127 in 2000, n = 60 in 2011), an increase in severe head injuries (Abbreviated Injury Scale (AIS) ≥ 3, including intracranial haemorrhage and skull fracture; n = 35 in 2000, n = 108 in 2011) and a 25% need for inpatient rehabilitation. Unfortunately, most of the causative effects on these changes are only speculative as they have not been measured in this study. The halving of hip fracture numbers is significant. The authors attribute this 6% per annum decrease to better falls prevention and pharmacological therapy of osteoporosis. Falls prevention decreasing injury contradicts the introductory statement of falls being an increasing cause of hospitalization. A trend for falls in their institution is not provided, only an absolute number of admission over 11 years (n = 4964) and the figures for 2000 (n = 354) and 2011 (n = 361), which makes it difficult to interpret whether falls prevention is responsible. It is difficult to interpret what proportion received osteoporosis pharmacotherapy, as trauma registries are generally not designed to this detail. Nationally, incidence of geriatric hip fracture is decreasing, despite an increasing number of cases because of an ageing population.4 If the population in the hospital's catchment has not expanded, or not aged at the same rate as other areas, this may contribute to their finding. An increase in severe head injuries of 5.9% per annum is reported by the authors, who hypothesize that this may result from increased utilization of antiplatelet or anticoagulant agents. Once again, this is not clarified whether patients sustain a head injury, and what proportion of patients sustaining falls were taking blood-thinning medication. The trauma registry cannot answer this possible justification, and this finding warrants scientific explanation. The burden elderly patients place on rehabilitation facilities is an important finding in this study. As much focus is being justifiably placed on the need for acute orthogeriatric services to improve patient outcomes,5 the unavailability of prompt referral of trauma patients to rehabilitation after acute care can be frustrating for the clinician, and place strain on trauma resources. A trauma service cannot solve this problem; it needs a State or National health-level solution. The John Hunter Hospital in Newcastle, NSW, has reported an increased incidence of geriatric hip fracture over a decade (n = 413 in 2002, n = 431 in 2011; mean of 427 ± 20), with a significant increase in length of stay over this time (2.5% increase per annum between 2002 (median 11 (12) ) and 2011 (median 11 (14), P < 0.05).6 This may be due to a greater demand for rehabilitation services, but was not explored through limitation of our own databases. We have reported an inpatient mortality of 4.6% per annum in our study of management errors and impact on mortality,7 which is similar to the authors' 5%. Recent minimum data set collection in accordance with the Agency for Clinical Innovation's hip fracture guidelines indicate a rehab discharge rate of 51.2% for our institution. This needs to be extrapolated over a longer period. Examining our prospectively collected trauma database (consisting of patients meeting trauma call criteria and all trauma patients with Injury Severity Score (ISS) > 15 since 2009), 294 patients over the age of 65 sustained a head injury with AIS ≥ 3 from a fall less than 1 m (Fig. 1). This was a median of 62 patients per annum (interquartile range (IQR) 50,63), with a mean age of 77.3 (±8.0 standard deviation), median ISS of 16 (IQR 9,25), inpatient mortality of 16.3% and rehabilitation discharge destination of 26.5%. The authors report a mortality of 10% and rehab referral of 33%, which is similar to our potentially sicker data set (ISS is not mentioned for head injury group alone). Elderly trauma admissions sustaining serious head injury from fall less than 1 m (2009–2013). This paper highlights all the limitations of the registry-based studies; they are reasonable for hypothesis generation and monitoring long-term trends of limited data at best. An exciting development is the inception of the Australia New Zealand Hip Fracture Registry. It will form a tool to assess desired standards in hip fracture care, and hopefully annul problems encountered with retrospective coding of injuries by data managers (highlighted by the authors as a limitation of this study). With interest being shown in hip fracture demographics,3, 6 preventable management errors7 and the impact of orthogeriatric groups,5 this will be a powerful tool to unite institutions motivated to assess changing demographics and standards of treatment, and ultimately institute change." @default.
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• W1526183089 date "2015-04-01" @default.
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• W1526183089 title "Low-energy falls" @default.
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• W1526183089 doi "https://doi.org/10.1111/ans.13002" @default.
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