Is There Any Difference in the Outcome of Geriatric and Non-Geriatric Severely Injured Patients?—A Seven-Year, Retrospective, Observational Cohort Study with Matched-Pair Analysis

Abstract

Geriatric trauma is expected to increase due to the lifestyle and activity of the aging population and will be among the major future challenges in health care. Therefore, the aim of this study was to investigate differences between polytraumatized geriatric and non-geriatric patients regarding mortality, length-of-stay and complications with a matched pair analysis. We included patients older than 17 years with an Injury Severity Score (ISS) of 16 or more admitted to our level 1 trauma center between January 2008 and December 2015. The cohort was stratified into two groups (age < 70 and ≥ 70 years). One-to-one matching was performed based on gender, ISS, mechanism of injury (penetrating/blunt), Glasgow coma scale (GCS), base excess, and the presence of coagulopathy (international normalized ratio (INR) ≥ 1.4). Outcome was compared using the paired t-test and McNemar-test. A total of 1457 patients were identified. There were 1022 male (70%) and 435 female patients. Three hundred and sixty-four patients (24%) were older than 70 years. Matching resulted in 57 pairs. Mortality as well as length-of-stay were comparable between geriatric and non-geriatric polytraumatized patients. Complication rate (34% vs. 56%, p = 0.031) was significantly higher in geriatric patients. This indicates the possibility of similar outcomes in geriatric polytraumatized patients receiving optimal care.

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

“…Overall, our findings match well with previous studies that were performed at a single large level one Trauma center in the TraumaNetzwerk DGU ® : these studies showed very similar trends concerning admissions, injury patterns, and outcome [21,49].…”

Extremity fractures, attempted suicide, blood transfusion and thromboembolic events are independent risk factors for a prolonged hospital stay in severely injured elderly

“…A total of 202,817 patients from the TR-DGU were checked for eligibility. The median hospital length of stay was 18 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] days. A total of 6,335 deceased (median length of stay 2[1-6] days) were excluded from further analysis just as 1,441 deceased (LOS: 9 [6-13] days).…”

“…Previously, high ISS, TBI, co-morbidities, and the occurrence of complications during the inpatient stay were identi ed as predictors of long hospital stays following trauma [12,26]. Apart from that, a matched pair study detected that geriatric patients sustain more complications than their younger counterparts [27]. In one of the few studies looking at prolonged hospitalization of trauma patients, Trottier et al identi ed higher ISS as a risk factor in addition to advanced age [28].…”

Role of endocrine PACAP in age-related diseases

“…Nowadays 23% of all trauma admissions involving patients over 65 years, and trauma associated death is the fifth leading cause of death in the elderly. Aging is associated with decreased physical reserve, and the immune response is slower and less intense, leading to increased infection and wound complication rates, therefore mortality rates in the geriatric population are increased, even when controlling for existing comorbidities (118)(119)(120)(121). The sympathetic nervous system and the hypothalamo-hypophyseal-adrenal axis are unquestionably involved in different critical diseases.…”