July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
ELDERLY PATIENT DISPOSITIONS AFTER OCULAR TRAUMA
Author Affiliations & Notes
  • Catherine He
    Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, New York, United States
  • Afshin Parsikia
    Surgery (Trauma), Jacobi Medical Center, Bronx, New York, United States
  • Joyce Mbekeani
    Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, New York, United States
    Surgery (Ophthalmology), Jacobi Medical Center, Bronx, New York, United States
  • Footnotes
    Commercial Relationships   Catherine He, None; Afshin Parsikia, None; Joyce Mbekeani, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 2313. doi:
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      Catherine He, Afshin Parsikia, Joyce Mbekeani; ELDERLY PATIENT DISPOSITIONS AFTER OCULAR TRAUMA. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2313.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Falls are the most common mechanism of trauma in the elderly, accounting for $34 billion in direct medical costs. Poor visual outcomes from ocular trauma increase the likelihood of future falls, underscoring the need for appropriate rehabilitation. This study aims to analyze patterns of elderly dispositions after ocular trauma.

Methods : A retrospective study of National Trauma Data Bank (NTDB 2008-2014) was conducted and patients >65yrs with ocular trauma were identified using ICD-9 codes. Analysis was performed with Chi-squared test, student’s t-test and odds ratios (OR) calculations, using SPSS software. Statistical significance was set at p<0.05.

Results : 58,074 (18.3%) of 316,485 patients admitted with ocular trauma were >65yrs. 45.4% were discharged home and 40.1% to advanced care settings (ACS). Whites were more likely discharged to ACS (OR=1.30, CI=1.24-1.36; p<0.001). Patients with severe injury severity score (ISS >25) were discharged to advanced care (OR=3.84, CI=3.56-4.15) and minor ISS (<15) patients, discharged home (OR=2.37, CI=2.28-2.47); p<0.001. Similarly, patients with all forms of traumatic brain injury (TBI) had greater odds of ACS placement (OR=1.30, CI=1.26-1.35) and those with severe TBI (Glasgow Coma Score {GCS} < 8) had 4.57 times (CI=4.09-5.11) the odds. Patients with Medicare insurance had greatest odds of ACS placement (OR=1.14, CI=1.09-1.19) compared to other insurance holders while self-pay patients were mostly discharged home (OR=2.24, CI=1.91-2.63); p<0.001. Patients aged 86-95 years had greater odds of discharge to an ACS than all younger patients (OR=1.95, CI=1.87-2.05; p<0.001). Elderly from the Northeast were most likely to be sent to an ACS compared to all other regions (OR=1.48, CI=1.42-1.54; p<0.001). Patients living in residential institutions prior to injury had 4.8 times (CI=4.40-5.14; p<0.001) likelihood of discharge to an ACS compared to those who were not. Multivariate logistic regression analysis revealed that the most important factors for ACS placement after admission with ocular trauma were, in order: ISS>25, GCS<8, Medicare insurance and residential institution occupancy.

Conclusions : Discharge to advanced care settings were most likely given to patients with the most severe ISS and GCS, Medicare insurance and those living in residential institutions. Understanding and addressing these disparities will assist in developing guidelines for provision of appropriate post-trauma rehabilitation.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

 

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