Major trauma in elderly – predictors of survival
Abstract
Background: Injury will soon become a disease more closely associated with elderly and not just a problem that affects young members of our society. Data about the outcome of polytraumatized elderly patients might have consequences on therapeutic strategies and health care planning.
Material and methods: A total of 41 patients met the inclusion criteria: age > 65 years, blunt trauma, major injury to at least two bodily regions, Injury Severity Score (ISS) at least 18. Mortality, factors that predict mortality and functional ability 1 year after injury were reviewed. The standardized form was used for the purpose of collecting of data. The following data were obtained: age, sex, mechanism of injury, pre-existing medical conditions, injury type and severity and complications.
Results: In-hospital mortality was 39 %. Female patients were more likely to die following trauma as male patients. Severe thoracic injury was found to correlate with mortality. The mean ISS was 31.3 (SD 11.3). The mortality correlates closely with ISS. The TRISS methodology yielded the W statistic = –0.15 and Z which was not significant. The normal admitting physiologic status of the patient could be misleading. Complications following trauma occurred in 78 % of our patients. 85.7 % patients had 10 or more points out of 12 on the FIM index one year after injury.
Conclusions: The death rate in hospitalized geriatric trauma victims was high. The sum of injuries was the best outcome predictor in the study group. Physiologic parameters of injury severity were insufficient in predicting survival for these elderly patients. Further studies are needed to adjust the treatment algorithms in elderly patients. Data could be obtained through national trauma registry.
Downloads
References
Anon. Statistični letopis Republike Slovenije. Ljubljana: Statistični urad republike Slovenije; 1997.
Komadina R, Rok-Simon M. Bone and joint decade 2000–2010. Zdrav Var 2002; 35: 7.
Santora TA, Schinco MA, Trooskin SZ. Management of trauma in the elderly patients. Surg Clin North Am 1994; 74: 163–86.
Champion HR, Copes WS, Buzer D, Flanagan ME, Bain L, Sacco WJ. Major trauma in geriatric patients. AJPH 1989; 79: 1278–82.
Finelli FC, Jonsson J, Champion HR, Morelli S, Fouty WJ. A case control study for major trauma in geriatric patients. J Trauma 1989; 29: 541–8.
McGwin G, Sherry MM, May AK, Rue LW. Long-term survival in the elderly after trauma. J Trauma 2000; 49: 470–6.
Lonner JH,Koval KJ. Polytrauma in elderly. Clinical Ortho Rel Res 1995; 318:136–43.
Anon. Advanced trauma life support. Chicago: The American College of Surgeons; 1994.
Tscherne H, Regel G, Sturm JA, Friedl HP. Schweregrad und Prioritaten bei Mehrfachverletzungen. Chirurg 1987; 58: 631–40.
Buhanec B, Brilej D, Komadina R, Vlaovic M. Quality control and improvement of care in treatment of polytraumatized patients in Celje from 1992 to 1999. Zdrav Vestn 2001; 70 Supl I: 31–4.
Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma 1989; 29: 623–29.
Baker SP, O‘Neil B, Haddon W, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14: 187–96.
Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: The TRISS method. J Trauma 1987; 27: 370–8.
Sacco WJ, Copes WS, Bain LW, MacKenzie EJ, Frey CF, Hoyt DB. Effect of preinjury illness on trauma patient survival outcome. J Trauma 1993; 35: 538–42.
Copes SC, Stark MM, Lawnick MM, Tepper S, Wilkerson D, DeJong G. Linking data from national trauma and rehabilitation registries. J Trauma 1995; 40: 428–36.
Matthews DE, Farewell VT. Using and understanding medical statistics. Basel: S. Krager; 1985.
Milzman DP, Boulanger BR, Rodriguez A, Soderstrom CA, Mitchell KA, Magnant CM. Pre-existing disease in trauma patients: A predictor of fate independent of age and injury severity score. J Trauma 1992; 32: 236–44.
Stare J. Relative risk and odds ratio. Zdrav Vestn 1998; 67: 297–9.
Glantz SA, Slinker BK. Primer of applied regression and analysis of variance. New York: McGraw Hill; 1990.
Osler T, Kales K, Baack B, Bear K, Hsi K, Pathak D. Trauma in elderly. Am J Surg 1988: 537–43.
Van der Sluis CK, Klasen HJ, Eisma WH, ten Duis HJ. Major trauma in young and old: What is the difference? J Trauma 1996; 40: 78–82.
Tornetta P, Mostafavi H, Riina J, Turen C, Reimer B, Levine R (1996) Morbidity and mortality in elderly trauma patients. J Trauma 1996; 46: 702–6.
Knudson MM, Lieberman J, Morris JA, Cushing BM, Stubbs HA. Mortality factors in geriatric blunt trauma patients. Arch Surg 1994; 129: 448–53.
McMahonDJ, Shapiro MB, Kauder DR. The injured elderly in the trauma intensive care unit. Surgical clinics of North America 2000; 80: 1005–19.
Mandavia D, Newton K. Geriatric trauma. Emerg Med Clin North Am 1998; 16: 257.
Kilaru S, Garb J, Emhoff T, Fiallo V, Simon B, Swiencicki T, Lee KF. Long term functional status and mortality of elderly patients with severe closed head injury. J Trauma 1996; 41: 957–63.
DeMaria EJ, Kenney PR, Merriam MA, Casanova LA, Gann DS. Aggressive trauma care benefits elderly. J Trauma 1987; 27: 1200–5.
Broos PLO, D‘Hore A, Vanderschot P, Rommens PM, Stappaerts KH. Multiple trauma in elderly patients. Factors influencing outcome: importance of aggressive care. Injury 1993; 24: 365–8.
Pickering SAW, Esberg D, Moran CG. The outcome following major trauma in the elderly. Predictors of survival. Injury 1999; 30: 703–6.
Scalea TM, Simon HM, Duncan AO, Atweh NA, Sclafani SJA, Phillips TF. Geriatric blunt multiple trauma: Improved survival with early invasive monitoring. J Trauma 1990; 30: 129–36.
Aufmkolk M, Majetschak M, Voggenreiter G, Obertacke U, Schmit-Neuerburg KP. Verlauf und prognose schwerer Unfallverletzungen im Alter. Unfallchirurg 1997; 100: 477–482.
Oreskovich MR, Howard JD, Copass MK, Carrico CJ. Geriatric trauma: Injury patterns and outcome. J Trauma 1984; 24: 565–9.
Van Aalst JA, Morris JA, Yates HK, Miller RS, Bass SM. Severely injured geriatric patients return to independent living: A study of factors influencing function and independence. J Trauma 1991; 31: 1096–101.
Battistella FD, Din AM, Perez L. Trauma patients 75 years and older: Long term follow-up results justify aggressive management. J Trauma 1998; 44: 618–23.
Clark DE, CHU MK. Increasing importance of the elderly in a trauma system. American Journal of Emergency Medicine 2002; 20: 108–11.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
