Survey of Elderly Trauma Patients with Prolonged Emergency Department Stays

SUMMARY 

Background

This study was undertaken to determine the factors occurring in elderly trauma patients that cause emergency department (ED) physicians to spend much time evaluating them, thereby delaying their discharge or admission, and how misdiagnosis or malpractice can be avoided. A subgroup of elderly and severely injured patients in the ED was examined, and their disposition and eventual temporal efficiency were determined.

Methods

A retrospective review of the trauma registry and medical records over a 2-month period (May 2002 to June 2002) identified 400 patients as trauma patients. Variables selected for examination included age, sex, length of ED stay, arrival time, injury severity triage, injury types, disposition, and times at registration, physician attendance, reports returned and discharge/leaving. Time-consuming measures were obtained in patients requiring different stations, and the durations were tested for all patients attending the Mackay Memorial Hospital ED.

Results

Among the 400 patients, the mean length of ED stay was 118.3 minutes (range, 94.7–350.2 minutes) and the mean age was 33.3 years (range, 1–92 years). In our age subgroups, the young group (< 18 years) contained 74 patients (18.5%), the middle-aged group (18–65 years) contained 290 patients (72.5%), and the elderly group (> 65 years) contained 36 patients (9.0%). On stratifying the durations by the three age groups, there were significant differences for D3 (duration of total treatment; p < 0.05) and D6 (duration of waiting for reports; p < 0.001). The elderly group had longer waits and longer stays than the other groups. The correlation between the age groups and attending doctors was significantly different (p < 0.001). The elderly group had a tendency to be attended by senior doctors and had the shortest waiting time among the groups (1.69 ± 0.32 minutes). In all three age groups, the waiting time for senior doctors was shorter than those for junior doctors or residents.

Conclusion

Despite tremendous resource utilization, the majority of elderly trauma patients with prolonged ED stays had varying degrees of triage level. A subgroup of severely injured elderly patients had a significantly shorter waiting time when attended by senior doctors. However, the elderly trauma patients who entered our ED facility fared as well as the younger patients.

Key Words:  elderly , emergencies , length of stay , trauma

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