When to Admit to Observation: Predicting Length of Stay for Anticoagulated Elderly Fall Victims

Authors

Kathleen M. O'Neill, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Raymond A. Jean, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.Follow
Alisa Savetamal, Department of Surgery, Yale-New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut.Follow
Ann Dyke, Department of Surgery, Yale-New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut.
Roseanne Prunty, Department of Surgery, Yale-New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut.
Andrew Stone, Department of Surgery, Yale-New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut.Follow
Andrea Castillo, Department of Surgery, Yale-New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut.
Shea C. Gregg, Department of Surgery, Yale-New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut.Follow

Document Type

Article

Publication Title

The Journal of surgical research

Abstract

BACKGROUND: Geriatric patients who fall while taking an anticoagulant have a small but significant risk of delayed intracranial hemorrhage requiring observation for 24 h. However, the medical complexity associated with geriatric care may necessitate a longer stay in the hospital. Little is known about the factors associated with a successful observational status stay (<2 d) for this population. MATERIALS AND METHODS: Elderly patients who fell while taking an anticoagulant admitted from 2012 to 2017 at an ACS level II trauma center were included in a retrospective cohort study to determine what factors were associated with a stay consistent with observational status. INCLUSION CRITERIA: age> 65 y old, negative initial head CT, and one of the following: INR>3.5 if on warfarin, GCS<14, external signs of trauma, or focal neurological deficits. RESULTS: The cohort included 369 patients. Factors associated with decreased likelihood of successful observational status included the need for services after discharge such as an extended care facility (OR 0.06, 95% CI 0.02-0.19, P < 0.001) or visiting nurse agency services (OR 0.27, 95% CI 0.10-0.75, P < 0.001), a dementia diagnosis (OR 0.17, 95% CI 0.04-0.70, P = 0.014), increasing number of medications (OR 0.91, 95% CI 0.84-0.99, P = 0.031), and the use of coumadin (OR 0.28, 95% CI 0.12-0.70, P = 0.006). CONCLUSIONS: For trauma providers, knowing your patient's medication use and particularly type of anticoagulant, comorbidities including dementia, and likely need for services after discharge will help guide the decision to admit the patient for what may be a reasonably lengthy stay versus a brief observation in the hospital for elderly fall victims on anticoagulation.

First Page

156

Last Page

160

DOI

10.1016/j.jss.2020.01.006

Publication Date

6-1-2020

Recommended Citation

O'Neill, Kathleen M.; Jean, Raymond A.; Savetamal, Alisa; Dyke, Ann; Prunty, Roseanne; Stone, Andrew; Castillo, Andrea; and Gregg, Shea C., "When to Admit to Observation: Predicting Length of Stay for Anticoagulated Elderly Fall Victims" (2020). Surgery. 10.
https://scholar.bridgeporthospital.org/surgery/10