OTA 2013 Posters

Scientific Poster #31 Geriatric OTA 2013

Risk Factors for Inpatient Mortality in High-Energy Geriatric Trauma Patients With Shoulder Girdle Fractures

Sanjit R. Konda MD; Matthew Wilson, MD; Rachel Seymour, PhD;
Madhav A. Karunakar, MD;
Carolinas Medical Center, Charlotte, North Carolina, USA

Background/Purpose: Observational studies involving shoulder girdle fractures (clavicle and/or scapula) have primarily evaluated a younger cohort of patients (age <50 years) and found a high incidence of associated traumatic injuries but minimal correlation with mortality. We sought to evaluate shoulder girdle fractures (+ShG Fx) in high-energy geriatric trauma patients (HE-GTPs) and compare them to a similar cohort of patients without shoulder girldle fractures (–ShG Fx) to determine differences in injury profile and inpatient mortality.

Methods: We conducted a retrospective review of prospectively collected data entered into the North Carolina Trauma Registry for all geriatric trauma patients (age ≥55 years) who presented to our Level I trauma center from 2008 to 2011. High-energy mechanisms of injury were defined as falls from height, motorcycle and motor vehicle crashes, and pedestrians struck by motor vehicles. We identified 1605 HE-GTPs of whom 139 (8.7%) had +ShG Fx and 1466 (91.3%) had –ShG Fx. We performed univariate analysis to compare inpatient mortality rates for both cohorts based on mechanism of injury and associated traumatic injuries. We used multivariate logistic regression analysis to determine which traumatic injuries were drivers of inpatient mortality for +ShG Fx.

Results: The overall mortality rate for +ShG Fx was 2.1 times higher than patients with –ShG Fx (13.7% vs 6.4%, P <0.01); however, multivariate analysis showed that +ShG Fx was not an independent risk factor for mortality (odds ratio [OR] 1.2, P = 0.03). In all HE-GTPs, mortality was driven by thoracic injuries (OR 1.4, P <0.01), abdominal/pelvic organ injuries (OR 1.6, P <0.01), injury to major blood vessels (OR 2.7, P <0.01), and intracranial injuries (OR 3.4, P <0.01). Mean injury severity scores were higher for +ShG Fx compared to –ShG Fx (23.4 ± 10.6 vs 12.5 ± 10.8, P <0.01). Correspondingly, +ShG Fx had an increased incidence of extremity and pelvic/sacral fractures as well as intracranial, thoracic, abdominal/pelvic organ, and major blood vessel injury (P <0.05). Mortality rates were found to be significantly higher for +ShG Fx with concomitant pelvic/sacral fractures (24.2% vs 15.3%, P <0.01) and intracranial injuries (27.1% vs 14.0%, P <0.01). Multivariate analysis revealed that the significant drivers of mortality in +ShG Fx were abdominal/pelvic organ injury (OR 2.4, P = 0.03) and intracranial injury (OR 4.4, P <0.01). +ShG Fxs were 5.4 times more likely than –ShG Fxs to sustain a combined intracranial and pelvic/abdominal organ injury (10.8% vs 2.0%, P <0.01) and these patients had a mortality rate of 46.7%.

Conclusion: HE-GTPs with +ShG Fx have a higher incidence of mortality than those –ShG Fx, which is in contrast to recent studies looking at these injuries in young adults. However, +ShG Fx is not an independent risk factor for mortality. +ShG Fxs have an increased incidence of associated traumatic injuries involving many different organ systems/body regions and the risk factors contributing to increased inpatient mortality in this cohort are abdominal/pelvic organ injuries and intracranial injuries. The presence of +ShG Fx in HE-GTPs, which is readily evaluated on injury chest radiographs, warrants thorough evaluation for associated traumatic injuries, particularly intracranial and abdominal/pelvic injuries, and appropriate triage to monitored settings given the high-mortality rate of this cohort.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.