The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study.

Introduction: This study compares outcomes between rural and urban geriatric trauma patients at a major trauma centre in South Africa. Materials and Methods: This retrospective cohort study from a prospectively entered data set, reviewed all patients aged 65 years or above admitted between January 2013 to December 2020 to our trauma centre at Grey's Hospital, South Africa. Results: Over the 8-year study period, a total of 323 patients aged ≥ 65 years were included (201 males (62%), mean age: 72 years. Mechanism of injury: 257 blunt (80%), 52 penetrating (16%) and 14 others (4%). The median Injury Severity Score (ISS) was 9. The median Charlson Comorbidity Index (CCI) for all 323 cases was 3. The median length of hospital stay was two days. The overall mortality was 12%. The crude odds ratio (OR) for death in rural vs urban patients was 2.51 (95% CI 1.27 - 4.94). After propensity score stratification for ISS, heart rate (HR), respiratory rate (RR), Glasgow Coma Scale (GCS) and temperature, and adjustment for mechanism, operation, Intensive Care Unit (ICU) and need for mechanical ventilation, the risk of death among the rural patients remained higher than in urban patients at 2.46 times (p=0.063), however, it was not statistically significant. Those who were operated on were significantly less likely to die after adjustment for confounding factors. Admission to ICU and the need for mechanical ventilation were significantly associated with mortality. Conclusion: Rural geriatric trauma patients have worse outcomes than urban geriatric trauma even after adjustment for differences in demographic and injury profile.