Outcomes of elderly trauma patients discharged from the emergency department: predictors of revisit, admission, and mortality; systematic review

Background: Older trauma patients discharged from the emergency department (ED) remain at risk of adverse outcomes. Predictors of revisit, admission, and mortality are not well studied. Methods: This systematic review identified studies of adults aged 65 years or older discharged from the ED after trauma-related presentations. A total of 190 records were identified from electronic databases. After removal of duplicates and other ineligible records, 33 full-text reports were assessed and 6 observational studies were included in the qualitative synthesis. Results: Included studies focused on fall-related trauma. Follow-up ranged from 3 days to 1 year. Reported outcomes included ED revisit, later hospital admission, recurrent falls, and mortality. ED revisits reached 25% at 1 year in one cohort, while another study reported 42.6% revisits and 31.1% later hospitalization within 6 months. Early 7-day revisits were reported in 11.7% of discharged fall patients. Mortality ranged from 1.2% at 3 days to 15% at 1 year in one study, and 10.4% 30-day mortality in another. Important predictors included male sex, higher comorbidity burden, older age, injury severity, abdominal or extremity injury, sedative or psychological medication use, psychiatric diagnosis, and alcohol or substance use disorder. Conclusion: Elderly trauma patients discharged from the ED were a high-risk group and benefit from discharge planning and transitional care.