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Trauma and Injury Prevention Section Newsletter - Autumn 2015

Geriatric Trauma Edition

 

Chair's Corner

Ali RajaAfter the success of our first themed issue on opioids earlier this year, we’ve decided not to mess with success and continue with theme-specific newsletters. This edition shines a spotlight on geriatric falls, a major focus of both the Trauma and Injury Prevention and Geriatric Emergency Medicine Sections. In this issue, once again organized by our outstanding Newsletter Editor, Dr. Elizabeth Johnson, we have a number of experts discussing the topic as a lead-in to our joint panel discussion during ACEP. Please join us on October 26th from 1-3pm in the Westin Waterfront in Grand Ballroom A for our annual Section Meeting (1-2pm) and a combined TIPS/GEMS panel discussion (2-3pm).

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Some Key Facts on Geriatric Fall-Caused Injuries Treated in US Emergency Departments

David C. Schwartz, Ph.D.Fall-caused injuries among elders have become a huge, growing, costly, deadly public health crisis in America. This brief note provides some key facts which may help Emergency Departments initiate or intensify fall prevention activities. Two suggestions are offered as to the ways in which ED physicians can achieve better fall prevention outcomes.

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Mechanical Falls

Shan LiuThe term “mechanical falls” has become commonly used in emergency departments, yet its definition and clinical implications have not been established. It implies that an external force or object led to the fall. Given that a third of older adults in the United States falls annually, over 2 million older adult non-fatal falls are treated annually in the ED1 and likely to increase as the older adult population grows,2,3 it is important to understand what is often termed “mechanical falls.”

While over a quarter of community-dwelling older adults have falls related to slipping, tripping, or stumbling,4,5 external factors are seldom the only cause of an older adult’s fall. Since older adult fall patients are at high risk for recurrent falls,6,7 ED evaluation should focus on determining such patients’ modifiable fall risk factors. Often, patients with “mechanical falls” have evaluations that focus on any fall-related injury whereas “non-mechanical falls” are often evaluated for potential cardiac etiologies for their fall. This dichotomy of “mechanical” vs. “non-mechanical” may lead to a less-thorough evaluation of the fall as older adult falls are multifactorial.6

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Online Resources Available to Providers for the Prevention of Geriatric Falls

Johnson2015As members of the American College of Emergency Physicians Trauma and Injury Prevention Section we strive to improve patient outcomes through…well prevention. Each year, $34 billion dollars are spent on treating elderly citizens (>64 years of age) with two thirds of this amount being spent on emergency department and hospital costs. One out of five falls in the elderly result in fractures or head injury with falls being the most common cause of traumatic brain injury in this demographic. Unlike in younger populations, even simple falls in the elderly can have long term effects on health and quality of life.

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Trauma Challenges in the Geriatric Patient: Predicting Short-Term Adverse Outcomes Prior to ED Discharge

Carpenter_Headshot2Case Scenario
An 80-year-old female presents to your emergency department (ED) after a standing level fall. She reports multiple prior falls in the preceding 12-months and states that she is walking more because her children took away her driver’s license 2 years ago after she had a minor car accident. Today’s triage note listed a history of atrial fibrillation treated with warfarin and her INR is 2.9. In addition, her medications included treatment for hypertension and hyperlipidemia. Your primary and secondary exam reveals left hip tenderness and a coccyx contusion, but no other injury. After observing her for 4-hours in the ED and noting an unremarkable hip and pelvic x-ray, CT-head and C-spine imaging, and no free fluid on POC FAST exam, you ambulate her and note no difficulty with the Get-Up-and-Go test. She wants to be discharged home and her primary care physician agrees via telephone that she should be discharged with follow-up in his office the next day. Her family has reservations about her home safety, but also agree that her perspectives should be respected and she is discharged home with next day follow-up.

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