Table 4.

Examples of Abstraction Narratives Describing Emergency Department (ED) Visits with Suspicious Circumstances of Presentation and/or Injury Patterns for Injuries not Identified as Due to Abuse among Known Victims of Physical Elder Abuse, 1981-1994

Narrative	Suspicious Circumstances or Presentation and/or Injury Patterns
Patient presents to ED via ambulance complaining of right shoulder injury. Patient slipped and fell down 3-4 stairs at home. Shoulder x-ray with compression fracture. Shoulder immobilized with swath and sling. Patient instructed: ice, tylenol. Follow up with Dr. [name redacted].	Upper extremity injury above the wrist *Injuries subsequently suspected by Elderly Protective Services (EPS) workers to have been related to abuse
Patient presents to ED complaining of left hip fracture after fall. Taken to operating room and treated with Austin-Moore hemiarthroplasty. Transferred to rehab services for post- operative physical therapy. Full thickness burn to right index finger was also noted that was treated by Plastic Surgery Department. Prognosis good. Discharge home. Patient aphasic and unable to give any history of injuries. Social work note discusses only spouse’s anxiety over patient’s recovery in time for daughter's wedding and details of transfer to rehab.	Atypical injury combination: burn and fracture
Patient presents to ED complaining of left rib pain. Patient reports she fell down 2 days ago. Patient was seen in ED 2 days ago with shortness of breath and did not mention falling at that time. Chest x-ray reveals multiple old rib fractures and new 5th rib fracture. Patient is discharged home, to follow up in ED clinic in 2 weeks.	Injury occurred >1 day before presentation Radiologic imaging with acute and older injuries
Patient’s daughter states that patient fell approximately 1 week ago at his home. She then brought patient to her home. She states that patient only complained of pain on his right side at that time. Pt is currently confused, disoriented, but it is unclear if he was confused prior to his fall. Family insists there has been a change in his mental status. Pt has a small avulsion on his left forehead and swollen upper lip. Chest x-ray, cervical spine x-ray, CT scan of head are all negative for acute findings. Patient diagnosed with facial bruises and baseline dementia. Patient was discharged home with daughter via wheelchair.	Injury occurred >1 day before presentation Maxillofacial injuries