Polytrauma in the elderly: predictors of the cause and time of death

Abstract

BackgroundIncreasing age and significant pre-existing medical conditions (PMCs) are independent risk factors associated with increased mortality after trauma. Our aim was to review all trauma deaths, identifying the cause and the relation to time from injury, ISS, age and PMCs.MethodsA retrospective analysis of trauma deaths over a 6-year period at the study centre was conducted. Information was obtained from the Trauma Audit and Research Network (TARN) dataset, hospital records, death certificates and post-mortem reports. The time and cause of death, ISS, PMCs were analysed for two age groups (<65 years and ≥ 65 years).ResultsPatients ≥ 65 years old were at an increased risk of death (OR 6.4, 95% CI 5.2-7.8, p < 0.001). Thirty-two patients with an ISS of >15 and died within the first 24 hours of admission, irrespective of age, from causes directly related to their injuries. Twelve patients with an ISS of <16, died after 13 days of medical conditions not directly related to their injuries (p = 0.01). Thirty four patients had significant PMCs, of which 11 were <65 years (34.4% of that age group) and 23 were ≥ 65 years (95.8% of that age group) (p = 0.02). The risk of dying late after sustaining minor trauma (ISS <16) is increased if a PMC exists (OR 5.5, p = 0.004).ConclusionElderly patients with minor injuries and PMCs have an increased risk of death relative to their younger counterparts and are more likely to die of medical complications late in their hospital admission.

High-energy Femur Fractures Increase Morbidity but not Mortality in Elderly Patients

“…It may be that patients who survive the early stresses of high-energy trauma have enough physiologic reserve to survive after hospital discharge. The association of mortality with ISS and age was seen in our study and has been confirmed in other studies [4,6,12,27]. The cumulative injuries, that is, the ISS and influence of physiologic reserve may play a greater role in mortality for this group of patients rather than the presence of a high-energy femur fracture.…”

“…Projected to be nearly 40% of total hospital trauma admissions by 2050 [10], elderly patients with trauma not only use 25% of hospital resources [28], but also are at increased risk for serious injuries [13]. Advanced age [4,12], Injury Severity Score (ISS) [4,6,14], male gender [12], preexisting conditions [2,[10][11][12], and in-hospital complications [6,20,21] have been associated with increased mortality rates in these patients. When compared with a younger population with trauma, elderly patients with trauma have higher mortality rates [10,11,16,18,26].…”

The geriatric polytrauma: Risk profile and prognostic factors

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] This pathophysiological restriction is demonstrated in increased mortality with greater age. [5,8,9,12,[17][18][19][20][21][22][23][24][25][26][27] In the present study, 4 times greater mortality was determined in the geriatric group compared with the younger patient group (65% vs 15.9%).…”

“…[3,5,6,18,20,21,[33][34][35][36]38,39,45,46] Volume resuscitation as soon as possible should raise systolic BP to at least 80 mmHg. In case of concomitant head and brain injury, systolic BP should even be at least 120 mmHg in order to maintain adequate cerebral perfusion and to prevent secondary brain injury.…”

“…Already limited pulmonary reserves [3,5,6,9,23] may be further reduced by trauma. For example, lung contusion may rapidly lead to hypoventilation and hypoxia, and can cause secondary brain injury.…”