30 / 290
was undertaken to investigate the role of ISS, comorbidity and
mechanism upon outcome (Glasgow outcome score, 30 day
mortality).
Results:
896 patients over the age of 65 years presented with
polytrauma and were compared to 1,363 patients under 65 years.
The mean age of the elderly group was 80 years (standard deviation
(SD) 8.6). Mean ISS was significantly lower in the elderly than the
young (16.6; SD 8.1 p < 0.0001), but more severe head injuries were
seen in the elderly (p < 0.0001) The elderly were 2.8 times more likely
to die (p < 0.0001) in the first 30 days, and 2.6 times more likely to have
a worse outcome score (p < 0.0001). UK trauma best practice did not
improve outcome in the elderly, but did improve outcome in the
young. Mechanism of injury, age and comorbidity were also significant
predictors of morbidity.
Conclusion:
This study proposes that mortality in the elderly
polytrauma patient is higher than previously thought. Further work
is needed to determine the best practice in early appropriate trauma
care in the elderly to improve survival.
O-082
First National Audit of In-patient Falls (NAIF, 2015) in England and
Wales
R. Schoo
1
, N. Vasilakis
1
, R. Stanley
1
, F. Martin
1
, S. Rai
1
, S. O
’
Riordan
1
.
1
Royal College of Physicians (RCP), London, United Kingdom
Introduction:
Falls in hospital are the most commonly reported
patient safety incidents. They can result in serious injuries, slower
recovery and increased costs. Our aim was to assess compliance of
policies, protocols and clinical care of older acute hospital patients
with evidence-based national clinical guidance on preventing falls/
injuries [1,2].
Methods:
NAIF is a web-based audit, based on guidance. Questions
were piloted for clarity and feasibility. Responses are generally
categorical (yes/no). All acute hospitals were invited to participate.
Organisational data involved leadership, policies and protocols. The
clinical data was a snapshot collected from clinical records and patient
level observation of 30 patients aged 65+ on their third hospital day.
Results:
96% (179) of eligible providers participated. Missing data was
<2%. All respondents had falls prevention policies: most covered all
relevant areas of falls prevention. Falls risk prediction tools were used
by 73% although not advised by NICE as they are insufficiently
predictive. 90% providers returned clinical data, from 4,846 patients.
Overall, there was no association between hospital policies and the
documented clinical care. Compliance with falls related assessments
and care plans were: delirium 37%, medication reviews 46%, vision
48%, lying and standing blood pressure measurement 16%, continence
or toileting care 33%, mobility aid in reach 68%, call bell accessible 82%.
Key conclusions:
There is (i) disconnect between institutional
intentions and clinical practice, (ii) wide variation in national
compliance, and (iii) variation in what individual hospitals succeed
in achieving. These results may promote more consistent focus on a
standardised evidence-based approach.
References
[1] National Patient Safety Agency.
Slips trips and falls in hospital
.
London: NPSA, 2007.
[2] National Institute for Health and Care Excellence.
Falls: assessment
and prevention of falls in older people (CG161)
. Manchester: NICE,
2010.
O-083
Correlation between serum heat shock proteins level and the
prognoses of elderly ICU patients: a prospective study
Qing Cao, Fei Wang, Fang Liu, Shuyan Chen.
Xinhua Hospital Affiliated to
Shanghai Jiaotong University
Aim:
To investigate the association between serum cardiac markers
levels and the prognoses of elderly patients in intensive care unit
(ICU).
Method:
A total of 428 consecutively hospitalized elderly patients
(Age
≥
60 years), whowere critically ill on admission to Emergency ICU
and Elderly ICU were screened for eligibility and followed up during
their ICU stay. We collected each patient
’
s baseline characteristics,
including their Acute Physiology and Chronic Health Evaluation II
(APACHE II) scores, N-terminal pro-brain natriuretic peptide (NT-
proBNP), C-reactive protein (CRP), Heat Shock Proteins (HSP), cTnTand
CK-MB levels. The primary indicator was the mortality of elderly ICU
patients. Multivariate logistic regression analyses were performed to
identify independent predictors of ICU mortality. Net reclassification
improvement (NRI) and integrated discrimination improvement (IDI)
were used to assess the model for predictors of ICU mortality.
Results:
Multivariate logistic regression analysis revealed that
APACHE-II score, CRP, NT-proBNP, HSP, cTnT, and CK-MB level could
independently predict the prognoses of elderly ICU patients. Among
them, APACHE II had the greatest power to predict the mortality of
elderly patients in ICUs. The maximal Area under Curve (AUC) for CRP
level (0.633 ± 0.042) was less than that of NT-proBNP (0.712 ± 0.032)
(p < 0.01) but greater than that for cTnT (0.704 ± 0.031) (p < 0.01). NT-
proBNP had the highest power to predict the mortality of elderly
patients in ICUs, CRP and cTnT ranked second and third respectively.
The addition of HSP, cTnT and NT-proBNP to APACHE-II resulted in an
NRI of 19.45% (p < 0.01) and an IDI of 9.13% (p < 0.01). In the subgroup
with infection, the addition of HSP to APACHE-II resulted in increased
Cox & Snell R2 and Nagelkerke R2 as well as significantly different NRI
and IDI (p < 0.01).
Conclusion:
Serum cTnT and HSP level could independently predict
the mortality of elderly patients in ICUs. The addition of cTnT and HSP
level to APACHE-II score led to a significantly higher power to predict
the mortality of elderly ICU patients.
O-084
Prevalence of hyponatremia and risk of falls in elderly admitted in
Emergency Geriatric Medicine Unit
S. Boyer
1
, C. Gayot
1
, T. Dantoine
1,2
, A. Tchalla
1,2
.
1
Limoges University; IFR
145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and
Environment),
2
Geriatric Medicine Department, CHU Limoges, Limoges,
France
Objectives:
Hyponatraemia is the most common electrolyte disorder
in older adults. Some studies have found that it increases morbidity
and mortality. Approximately one in three older adults fall each year.
Dysnatremia may predispose to falls and fractures, and serum sodium
may influence bone health. Little is known of the association of
dysnatremia at Emergency Department (ED) and fall prevalence in
elderly admitted at ED. Therefore we are investigating the link
between hyponatraemia and risk of falls in elderly admitted in
Emergency Geriatric Medicine Unit.
Methods:
We conducted a cross sectional study during three months
including patients older than 75 years admitted to the Emergency
Geriatric Medicine Unit of the University Hospital Center of Limoges
(France). Socio-demographic factors, falls event, Comorbidities,
Medications, sodium levels were studied (hyponatraemia was con-
sidered Na+< 136 mmol/L) and the short-CGA variables including
SEGA (frailty score) and ADL.
Results:
Of 600 cases recruited, the mean age was 87 ± 5,9 an 65.3%
werewomen. The prevalence of falls was 24.7% 95% CI (21.5% to 28.5%).
The prevalence of hyponatraemia was 7.6% 95% CI (2.9% to 13.1%) in
patient without falls and 20% 95%CI (16.5% to 23.5%) in patient
admitted for falls. Hyponatremia was associated with falls of P < 0.001.
The adjusted OR was 3.7 95% CI (1.6
–
8.3).
Conclusion:
Given that hyponatraemia could be considered a risk
factor for falls, the inclusion of the determination of sodium level at
emergency department would be important for fall prevention
strategies in the elderly.
Oral presentations / European Geriatric Medicine 7S1 (2016) S1
–
S27
S24