Redefining geriatric trauma: 55 is the new 65

Abstract

As the prevalence of geriatric trauma patients has increased, protocols are being developed to address the unique requirements of this demographic. However, categorical definitions for geriatric patients vary, potentially creating confusion concerning which patients should be cared for according to geriatric-specific standards. The aim of this study was to identify data-driven cut points for mortality based on age to support implementation of age-driven guidelines. METHODS:Adults aged 18 to 100 years with blunt or penetrating injury were selected from 95 hospitals' trauma registries. Change point analysis techniques were used to detect inflection points in the proportion of deaths at each age. Based on these calculated points, patients were allocated into age groups, and their characteristics and outcomes were compared. Logistic regression was used to estimate risk-adjusted in-hospital mortality controlling for sex, race, Injury Severity Score, Glasgow Coma Scale, and number of comorbidities. RESULTS: A total of 255,099 patients were identified (female, 45.7%; mean age, 59.3 years; mean Injury Severity Score, 8.69; blunt injury, 92.6%). Statistically significant increases in mortality rate were noted at ages 55, 77, and 82 years. Compared with the referent group (age, <55 years), adjusted odds ratios (AORs) showed increases in mortality if age 55 to 76 years (AOR, 2.42), age 77 to 81 years (AOR, 4.70), or age 82 years or older (AOR, 6.43). National Trauma Data Standard-defined comorbidities significantly increased once age surpassed 55 years, as the rate more than doubled for each of the older age categories (p < 0.001). As age increased, each group was more likely to be female, have dementia, sustain a ground level fall, and be discharged to a skilled nursing facility (p < 0.001). CONCLUSION:This large multicenter analysis established a clinically and statistically significant increase in mortality at ages 55, 77, and 82 years. This research strongly suggests that trauma patients older than 55 years be considered for inclusion in geriatric trauma protocols.The other age inflection points identified (77 and 82 years) may also warrant additional specialized care considerations.

A Comparative Analysis of Hospital Triage Systems in the Geriatric Adult Trauma Patients: A Quality Improvement Pilot Study

“…12 Fakhry et al performed an epidemiological study and determined that 55 years old is on average in America when adverse outcomes due to trauma spikes sharply and advocated for everyone over 50 be included in geriatric trauma assessments. 13 Our data showed similar trends; specifically, individuals in the > 65-year-old age group do not benefit as clearly from screening using mTSFI. Furthermore, in this age group, the intracohort difference between concordance and discordance was only 6% (47% match, 53% mismatch) when comparing the default ESI with the mTSFI.…”

Provision of acute care pathways for older major trauma patients in the UK

“…There was lack of consensus as to which patients would be classified as old, with the chronological age ranging from 60 to 82 years. This inability to provide a strict definition is reflected in both policy and research with ‘old’ defined variously as starting at 55 years [ 33 ], 60 years [ 34 ] or 65 years [ 35 ]. A systematic review and meta-analysis of geriatric consults similarly found variation in the age cut-offs to define this patient group [ 36 ].…”

Crosswalk between Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status Score for Geriatric Trauma Assessment

“…The inclusion criteria consisted of adult patients aged 55 years and older, who were admitted through the emergency department, and who received orthopedic trauma care between 2014 and 2020 (N = 12,303) ( Figure 1 ). We used age 55 as the cutoff since injury-related mortality significantly increases from age 55 years and higher [ 4 ]. We restricted the data to cases that had an ASA-PS grade (n = 4229) and excluded cases that were ASA-PS grade 5 (n = 11).…”

“…These injuries commonly occur from falls, motor-vehicle crashes, and burn injuries [ 2 ], and approximately 80 percent of geriatric trauma cases are managed non-surgically [ 3 ]. Geriatric trauma patients, aged 55 years and older [ 4 ], are a unique trauma population that is at increased mortality risk compared to trauma patients less than 55 years old [ 5 , 6 , 7 , 8 , 9 ]. Multiple factors have been associated with increased geriatric trauma mortality risk, some of which include frailty [ 10 , 11 ], cognitive impairment [ 1 ], cardiovascular and pulmonary insufficiency [ 1 ], and poor injury triage [ 6 , 12 , 13 ].…”