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was undertaken to investigate the role of ISS, comorbidity and

mechanism upon outcome (Glasgow outcome score, 30 day



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.


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.


First National Audit of In-patient Falls (NAIF, 2015) in England and


R. Schoo


, N. Vasilakis


, R. Stanley


, F. Martin


, S. Rai


, S. O





Royal College of Physicians (RCP), London, United Kingdom


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].


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.


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.


[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,



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


To investigate the association between serum cardiac markers

levels and the prognoses of elderly patients in intensive care unit



A total of 428 consecutively hospitalized elderly patients


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.


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).


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.


Prevalence of hyponatremia and risk of falls in elderly admitted in

Emergency Geriatric Medicine Unit

S. Boyer


, C. Gayot


, T. Dantoine


, A. Tchalla




Limoges University; IFR

145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and



Geriatric Medicine Department, CHU Limoges, Limoges,



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.


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.


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



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