Emergency department and outpatient treatment of acute injuries in older adults in the United States: 2009-2010

Objectives: We sought to describe epidemiological patterns of acute injuries treated in emergency department (ED) and outpatient primary care settings in the United States.

Design: Retrospective cross-sectional analysis of data from the 2009 and 2010 National Health Care Surveys.

Setting: Emergency departments and outpatient primary care clinics.

Participants: Older adults (≥ 65) with initial visits for acute injuries.

Measurements: Frequencies and incidence rates of medically attended injury according to participant characteristics and care setting.

Results: Of the 19.7 million medically attended acute injuries in older adults in 2009-10, 50% were treated at EDs and 50% at outpatient primary care clinics. The annual incidence rate of medically attended injuries rose with age, from 20.8 (95% confidence interval (CI) = 17.0-24.6) per 100 in those aged 65 to 74 to 41.5 (95% CI = 33.5-49.4) per 100 for those aged 85 and older. Of injury-related ED visits, 60% occurred outside standard business hours, 36% were triaged as low acuity, and 25% resulted in admission. Only 9% of injury-related primary care visits had injury prevention counseling documented.

Conclusion: Medically attended injuries area common in older adults, and their incidence increases with advancing age. Half of all initial visits for acute injuries in older adults are to primary care clinics. Most injured individuals are discharged home, and injury prevention counseling is rarely documented. To inform injury prevention efforts appropriately and to avoid underestimating the burden of injury, future injury studies should include a range of outpatient and inpatient care settings.