Association of Hyponatremia with Outcomes After Geriatric Trauma: a Systematic Review and Meta-analysis

Overview

Journal Trauma Surg Acute Care Open

Specialty Critical Care

Date 2025 Feb 18

PMID 39963314

Authors

Ariana Naaseh

Steven Tohmasi

Carrie Stoll

Chongliang Luo

Lauren H Yaeger

Mark H Hoofnagle

Graham A Colditz

Marguerite W Spruce

Affiliations

Soon will be listed here.

Abstract

Background: Trauma is a major cause of mortality in the elderly population. Hyponatremia is the most common electrolyte imbalance in geriatric patients and has been demonstrated to be a risk factor for altered cognition, low bone density, falls, and death. We systematically and critically reviewed the literature to ascertain the association between hyponatremia and geriatric trauma outcomes.

Methods: We searched seven databases for articles published from inception to October 2023. Studies included reported on geriatric trauma, hyponatremia, and clinical outcomes. Two investigators independently reviewed 6535 abstracts, 235 full-text articles, and critically appraised each study. Study details, patient characteristics, and outcomes were independently extracted by two reviewers. Data quality assessment was performed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Publication bias was assessed using funnel plot-based methods. A meta-analysis of risk ratios (RR) was performed using the random effects method.

Results: Four retrospective cohort studies involving 11 894 geriatric patients were included. Among these, 492 (21.4%) were classified as trauma patients due to a fall and 1806 (78.6%) were classified as a trauma patient due to the presence of a fracture. In total, 2298 (19.3%) patients were classified as hyponatremic (125-135 mmol/L) while 9596 (80.7%) were classified as normonatremic. The pooled RR for in-hospital mortality for hyponatremic patients was 2.23 (95% CI 1.51 to 3.74) with high heterogeneity across the studies (I=82.17%).

Conclusions: Geriatric trauma patients presenting with hyponatremia appear to have an increased risk of in-hospital mortality. Given this association, national trauma registries should consider collecting serum sodium values for geriatric patients and providers should work to address hyponatremia as a possible contribution to falls. Given the paucity of published literature on this topic, there is a need for prospective studies evaluating the association between hyponatremia and geriatric trauma outcomes.

Level Of Evidence: Level III, systematic review with meta-analysis.

Citing Articles

Is hyponatremia after geriatric trauma the new frailty?.

Godier-Furnemont A, Bongiovanni T Trauma Surg Acute Care Open. 2025; 10(1):e001792.

PMID: 40066368 PMC: 11891520. DOI: 10.1136/tsaco-2025-001792.

References

Bulgakova S, Treneva E, Zakharova N, Nikolaeva A, Ovchinnikova E . Chronic hyponatremia in the elderly: association with geriatric syndromes (review of literature). Klin Lab Diagn. 2020; 65(10):597-601. DOI: 10.18821/0869-2084-2020-65-10-597-601. View

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

Finelli F, Jonsson J, Champion H, Morelli S, FOUTY W . A case control study for major trauma in geriatric patients. J Trauma. 1989; 29(5):541-8. DOI: 10.1097/00005373-198905000-00001. View

Fisher J, Bates C, Banerjee J . The growing challenge of major trauma in older people: a role for comprehensive geriatric assessment?. Age Ageing. 2017; 46(5):709-712. DOI: 10.1093/ageing/afx035. View

Usala R, Fernandez S, Mete M, Cowen L, Shara N, Barsony J . Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in a Large US Health System Population. J Clin Endocrinol Metab. 2015; 100(8):3021-31. PMC: 4524991. DOI: 10.1210/jc.2015-1261. View

Rittenhouse K, To T, Rogers A, Wu D, Horst M, Edavettal M . Hyponatremia as a fall predictor in a geriatric trauma population. Injury. 2014; 46(1):119-23. DOI: 10.1016/j.injury.2014.06.013. View

Morris Jr J, Mackenzie E, Damiano A, Bass S . Mortality in trauma patients: the interaction between host factors and severity. J Trauma. 1990; 30(12):1476-82. View

Jacobs D, Plaisier B, Barie P, Hammond J, Holevar M, Sinclair K . Practice management guidelines for geriatric trauma: the EAST Practice Management Guidelines Work Group. J Trauma. 2003; 54(2):391-416. DOI: 10.1097/01.TA.0000042015.54022.BE. View

Cagetti B, Cossu M, Pau A, Rivano C, Viale G . The outcome from acute subdural and epidural intracranial haematomas in very elderly patients. Br J Neurosurg. 1992; 6(3):227-31. DOI: 10.3109/02688699209002930. View

10.

Gerrish A, Hamill M, Love K, Lollar D, Locklear T, Dhiman N . Postdischarge Mortality after Geriatric Low-Level Falls: A Five-Year Analysis. Am Surg. 2018; 84(8):1272-1276. View

11.

Pennings J, Bachulis B, Simons C, Slazinski T . Survival after severe brain injury in the aged. Arch Surg. 1993; 128(7):787-93; discussion 793-4. DOI: 10.1001/archsurg.1993.01420190083011. View

12.

Guyatt G, Oxman A, Vist G, Kunz R, Falck-Ytter Y, Alonso-Coello P . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336(7650):924-6. PMC: 2335261. DOI: 10.1136/bmj.39489.470347.AD. View

13.

Oreskovich M, Howard J, Copass M, CARRICO C . Geriatric trauma: injury patterns and outcome. J Trauma. 1984; 24(7):565-72. View

14.

Gill G, Huda B, Boyd A, Skagen K, Wile D, Watson I . Characteristics and mortality of severe hyponatraemia--a hospital-based study. Clin Endocrinol (Oxf). 2006; 65(2):246-9. DOI: 10.1111/j.1365-2265.2006.02583.x. View

15.

McGwin Jr G, Maclennan P, Fife J, Davis G, Rue 3rd L . Preexisting conditions and mortality in older trauma patients. J Trauma. 2004; 56(6):1291-6. DOI: 10.1097/01.ta.0000089354.02065.d0. View

16.

Hagino T, Ochiai S, Watanabe Y, Senga S, Saito M, Takayama Y . Hyponatremia at admission is associated with in-hospital death in patients with hip fracture. Arch Orthop Trauma Surg. 2013; 133(4):507-11. DOI: 10.1007/s00402-013-1693-x. View

17.

Mc Causland F, Wright J, Waikar S . Association of serum sodium with morbidity and mortality in hospitalized patients undergoing major orthopedic surgery. J Hosp Med. 2014; 9(5):297-302. PMC: 4815900. DOI: 10.1002/jhm.2168. View

18.

Ayus J, Fuentes N, Go A, Achinger S, Moritz M, Nigwekar S . Chronicity of Uncorrected Hyponatremia and Clinical Outcomes in Older Patients Undergoing Hip Fracture Repair. Front Med (Lausanne). 2020; 7:263. PMC: 7338672. DOI: 10.3389/fmed.2020.00263. View

19.

Harbord R, Egger M, Sterne J . A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med. 2005; 25(20):3443-57. DOI: 10.1002/sim.2380. View

20.

Zhang X, Li X . Prevalence of hyponatremia among older inpatients in a general hospital. Eur Geriatr Med. 2020; 11(4):685-692. PMC: 7438367. DOI: 10.1007/s41999-020-00320-3. View