Clinicoepidemiological profile and outcome of geriatric trauma in the emergency department of tertiary care centre - an ambispective observational study

Geriatric trauma is a major public health concern in low- and middle-income countries such as India, where population aging, high-energy motor vehicle collisions, and increasing comorbidities contribute to disproportionate morbidity and mortality among older adults. Older patients exhibit atypical physiological responses and reduced physiologic reserve; however, Indian data on their emergency department (ED) presentations and outcome predictors remain limited. This study aimed to describe the clinico-epidemiological profile of geriatric trauma patients presenting to a tertiary ED and identify factors associated with in-hospital mortality. This ambispective observational study was conducted in the emergency department (ED) of a tertiary academic hospital in South India. We enrolled consecutive trauma patients aged ≥ 60 years who presented within 24 h of injury. Data collected included demographics; injury mechanism and severity; physiological parameters; injury patterns; and scores such as the Emergency Severity Index (ESI), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Geriatric Trauma Outcome Score (GTOS). Patients were followed until hospital discharge or death. Continuous variables were assessed for normality using the Shapiro-Wilk test and visual inspection of histograms and Q-Q plots. As all were non-normally distributed, continuous variables are presented as medians with interquartile ranges (IQRs), and categorical variables as frequencies and percentages. We compared survivors and non-survivors using the Mann-Whitney U test for continuous variables and chi-square or Fisher’s exact tests for categorical variables, as appropriate. Variables with p < 0.10 on univariate analysis, along with clinically relevant factors, were entered into a multivariable logistic regression model to identify independent predictors of in-hospital mortality. To minimize overfitting due to the limited number of outcome events, we restricted the number of predictors and excluded physiologically dependent variables, such as ESI and massive transfusion protocol (MTP) activation, from the final model. Multicollinearity was assessed using variance inflation factors (VIFs); influential outliers were evaluated using Cook’s distance and standardized residuals. The model was fitted using the enter method. Model calibration was assessed with the Hosmer-Lemeshow goodness-of-fit test, and explanatory power with Cox & Snell and Nagelkerke pseudo-R² values. We report adjusted odds ratios (AORs) with 95% confidence intervals (CIs); p < 0.05 was considered statistically significant. A total of 360 geriatric trauma patients were included (67.8% male; median age, 65 years [IQR, 62–70]). Motor vehicle collisions were the most common injury mechanism (56.9%), followed by falls (26.4%). Overall in-hospital mortality was 11.7% (42/360), with 83.3% of deaths occurring within the first week; traumatic brain injury accounted for 73.8% of deaths. On multivariate analysis, higher ISS (AOR, 1.10; 95% CI, 1.05–1.16), lower GCS (AOR, 0.71; 95% CI, 0.58–0.87), higher pulse rate (AOR, 1.05; 95% CI, 1.002–1.093), and cervical spine injury (AOR, 8.73; 95% CI, 1.1–68.5) independently predicted in-hospital mortality. GTOS showed good discrimination, with significantly higher scores among non-survivors. In this tertiary Indian ED, geriatric trauma resulted predominantly from high-velocity motor vehicle collisions and was associated with substantial early mortality, largely attributable to traumatic brain injury. Simple bedside variables (ISS, GCS, pulse rate) and geriatric-specific tools such as GTOS enabled early risk stratification. These findings highlight the need for geriatric-focused trauma protocols and system-level improvements to support rapid assessment and aggressive management in resource-limited emergency care settings. Not applicable.