An Appraisal of Trauma in the Elderly

Abstract

To review the trends of trauma in the elderly experienced at our trauma center compared with other Level I trauma centers. This was a retrospective trauma registry analysis (1996–2003) of 2783 blunt trauma in elderly (BTE) and 4568 adult (BTA) patients in a Level 1 trauma center. Falls and motor vehicular crashes were the most common mechanisms noted in 47 per cent and 31 per cent (84% and 13% in BTE, 25% and 42% in BTA). BTE were sicker, with higher Injury Severity Scores (ISS), lengths of stay, and mortality (5% vs 2%, P value < 0.05). ISS was 5.2-fold higher in nonsurvivors to survivors in BTA and 2.4-fold in BTE. Elevation in ISS resulted in higher linear increase in mortality in BTE ( vs BTA) at any ISS level. Mortality in patients with ISS ≥ 25 was 43.5 per cent vs 23.8 per cent. ISS ≥ 50 had 31 per cent adult survivors but no elderly survivors. Among isolated injuries, head trauma in the elderly carried the highest mortality, at 12 per cent (19% in patients with an Abbreviated Injury Score ≥3). Abdominal injuries were the most lethal (18.3% and 41.2% in patients with an Abbreviated Injury Score ≥3) in multiple trauma victims (41% vs 18% in isolated trauma). There was 4.4-fold increased mortality in the presence of thoracic trauma. Combined head, chest, and abdominal trauma carried the worst prognosis. Thirty-four per cent of BTE and 88 per cent of BTA patients were discharged home. Elderly patients need more aggressive therapy, as they are sicker with higher mortality.

Evaluation of the revised trauma and injury severity scores in elderly trauma patients

“…A recent study found that elderly patients with blunt trauma suffered a higher mortality at any ISS. [ 20 ] A study by Tornetta et al . addressed factors affecting morbidity and mortality in elderly trauma patients.…”

“…Elderly patients have a higher mortality for various reasons, including an increase in late mortality (>24 hours) due to in-hospital complications and a higher incidence of preexisting medical conditions, of which cardiac disease, diabetes mellitus, coagulopathy, neurologic disease, chronic obstructive pulmonary disease, malignancy, chronic kidney disease and liver disease were most commonly observed. [ 7 20 23 – 27 ]…”

Age Differences in Energy Absorption in the Upper Extremity During a Descent Movement: Implications for Arresting a Fall

“…Our results suggest that older women are substantially less able than young women to absorb energy in their upper extremities during a push-up task that simulates arresting a fall. This may contribute to the increase with age in the prevalence of fall-related hip fracture (10,11) and head and neck injury (12)(13)(14)(15). To place these results in the context of the ability to safely arrest a fall, it is useful to compare our observed energy absorptions with measures of the average energy content of a forward fall (16).…”

Perils of Rib Fractures

“…5,9,11,16 Falls historically accounted for 10 to 17 per cent of RF. Presently, falls are emerging as the most common etiology of trauma 23 due to a rapidly growing elderly population with fragile, osteopenic bones. Falls were the leading cause of trauma noted in 43 per cent of blunt injuries and 28 per cent of RF in this study.…”