Age-Dependent Patient and Trauma Characteristics and Hospital Resource Requirements—Can Improvement Be Made? An Analysis from the German Trauma Registry

Abstract

Background and objectives: The burden of geriatric trauma patients continues to rise in Western society. Injury patterns and outcomes differ from those seen in younger adults. Getting a better understanding of these differences helps medical staff to provide a better care for the elderly. The aim of this study was to determine epidemiological differences between geriatric trauma patients and their younger counterparts. To do so, we used data of polytraumatized patients from the TraumaRegister DGU®. Materials and Methods: All adult patients that were admitted between 1 January 2013 and 31 December 2017 were included from the TraumaRegister DGU®. Patients aged 55 and above were defined as the elderly patient group. Patients aged 18–54 were included as control group. Patient and trauma characteristics, as well as treatment and outcome were compared between groups. Results: A total of 114,169 severely injured trauma patients were included, of whom 55,404 were considered as elderly patients and 58,765 younger patients were selected for group 2. Older patients were more likely to be admitted to a Level II or III trauma center. Older age was associated with a higher occurrence of low energy trauma and isolated traumatic brain injury. More restricted utilization of CT-imaging at admission was observed in older patients. While the mean Injury Severity Score (ISS) throughout the age groups stayed consistent, mortality rates increased with age: the overall mortality in young trauma patients was 7.0%, and a mortality rate of 40.2% was found in patients >90 years of age. Conclusions: This study shows that geriatric trauma patients are more frequently injured due to low energy trauma, and more often diagnosed with isolated craniocerebral injuries than younger patients. Furthermore, utilization of diagnostic tools as well as outcome differ between both groups. Given the aging society in Western Europe, upcoming studies should focus on the right application of resources and optimizing trauma care for the geriatric trauma patient.

What effect did the New Zealand COVID‐19 lockdown have on computed tomography‐head scan utilisation in patients presenting to the emergency department with traumatic head injuries?

“…In NZ, it is estimated that those aged over 65 years will account for 26% of the population by 2051 22 . This supports the call to continue to shift the classic ED trauma paradigm 23 so that trauma care models better reflect outcomes relevant to injured elderly patients 24,25 …”

“…22 This supports the call to continue to shift the classic ED trauma paradigm 23 so that trauma care models better reflect outcomes relevant to injured elderly patients. 24,25 Limitations NZ's first lockdown was thankfully brief, but its short duration and small national population means that the study period is relatively short and the sample size small. It is also a single centre study of a major referral centre, so generalisability is limited.…”

Does the injury pattern drive the surgical treatment strategy in multiply injured patients with major fractures?

“…In general, isolated orthopedic injuries (pelvic, spinal, extremity) are usually not acutely life-threatening, and therefore, the acute management of such injuries may not be a priority. In addition, these injuries may be influenced by hospital resource availability 27,28 …”

“…In addition, these injuries may be influenced by hospital resource availability. 27,28 Truncal and musculoskeletal injuries have been investigated as separate entities in most studies. 12,[29][30][31] To address this issue, the present investigation includes all surgical procedures and management strategies, performed by both general and orthopedic trauma surgeons in the same patients.…”

Combined Odontoid (C2) and Atlas (C1) Fractures in Geriatric Patients: A Systematic Review and Treatment Recommendation

“…5,13 Generally, this is in line with other fractures in elderly people where a high proportion of fractures results from low-energy trauma. 20 This underlines the necessity of adequate diagnostics regardless of the trauma mechanism when symptoms are present or injury of the cervical spine is suspected.…”