Long term outcomes following pretibial injury: mortality and effects on social care

INTRODUCTION: Pretibial injuries are common, and those patients requiring hospital admission are often elderly with significant comorbidity. The long term impact on social care and associated mortality seen in this patient group has not been reported previously. It was our impression that pretibial injury is often a marker of increasing social and/or medical needs of the patient, and that a significant proportion of these patients underwent long term changes in social circumstances following injury. METHODS: A review of 109 patients with pretibial injuries over a 3-year period admitted to the Plastic Surgery Unit at Derriford Hospital, Plymouth, UK. Overall mortality and changes in social circumstances within a 6-month period following discharge from hospital were recorded. RESULTS: The overall mortality was 11%. Twenty-five percent of patients underwent an escalation of their social care requirements immediately on discharge from hospital. At 6 months only 78% of patients who were living independently at home prior to admission had returned home. Increasing age, cardiovascular comorbidities, length of time to operation were significantly associated with deterioration in social circumstances and death. CONCLUSIONS: Mortality following pretibial injury is higher than that expected for the population. A sizeable proportion of patients with pretibial injuries can be expected to need significant long term changes in social input after injury. Whether this change is directly due to injury, or is a reflection of underlying medical and social deterioration identified by the hospital admission process is unclear. In either respect, close liaison with medical and social care teams is essential to facilitate optimum care in this patient group.