A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

Abstract

Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017. Methods A descriptive analysis of the data from the TraumaRegister DGU® (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002–2005 (1), 2006–2009 (2), 2010–2013 (3) and 2014–2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared. Results In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4). Conclusion Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

Epidemiology, injury pattern and outcome of older Canadian trauma patients: a 15-year study of a provincial trauma registry

“…Older trauma patients are now more numerous than younger adults, which is also consistent with reported international information 2,3,21−27 . Our results also con rm previous ndings that falls are the most common injury mechanism among older adults 28,29 . Falls are also very prevalent in younger adults as they have interchangeably been the leading cause of trauma with MVC in that population.…”

“…An Australian study reported a signi cant increase in the population-adjusted incidence of thoracic injury (8%/year), with the greatest increase being in patients aged ≥ 85 years (14%/year) 30 . Other authors also reported an increasing number of older adults with spine injuries 29 . which are mostly the result of low-energy trauma and predominantly affect the axial cervical spine.…”

“…This was recently supported by other authors and could potentially be attributed to improved osteoporosis treatment but also to healthier lifestyle choices 35 . The evolution of injury pattern may also be attributed to improvements in diagnostic radiology 26 combined with the recent democratization of whole body computed tomography (WBCT) which became standard practice in many centres in the last two decades 29,36 .…”

“…This epidemiological study is a reliable overview of the Canadian trauma population as a whole, as other studies have focussed on speci c trauma mechanism 45 , or population 25,28,46 . In addition, studies exploring temporal changes in injury pattern and severity are sparse 26,28,29 . At last, because advanced age has been associated with undertriage 6-8 (inaccurate triage that results in a patient who requires higher-level care not being directly transported to a Level-I or Level-II trauma centre) we also included secondarily transferred patients.…”

Traumakinetik – Eine Frage der Geschwindigkeitsänderung

“…Die Größe, das Gewicht, das Alter und Vorerkrankungen haben ebenfalls einen Einfluss auf das Verletzungsmuster des Patienten nach einem traumatischen Ereignis. Besonders bei älteren Patienten (> 60 Jahre) ist nach einem Hochrasanztrauma mit Komplikationen zu rechnen, die häufig durch Vorerkrankungen, Einnahme verschiedener Medikamente (Polypharmazie) und Gebrechlichkeit (Frailty) begründet sind [6,7,12,15,16].…”