Unique pattern of complications in elderly trauma patients at a Level I trauma center

Abstract

Background Trauma centers are caring for increased proportions of elderly patients. While age and ISS are independently associated with mortality, trauma centers were originally designed to care for seriously injured patients without age-specific guidelines. We hypothesized that elderly patients would have different complication patterns than their younger counterparts. Methods The trauma registry of an ACS-verified level I trauma center was queried for all patients > 14 years of age admitted between 1/2005 and 12/2008. Mechanism, mortality, and complications were evaluated after dividing patients into eight age groups. Results Of the 15,223 patients, 13% were elderly (≥ 65), and 86% were injured via a blunt mechanism. Increasing age correlated with fatality (all ISS scores), end-organ failure and thrombo-embolic complications (DVT and coagulopathy). Analysis revealed a significant breakpoint at 45 years of age for mortality, decubiti and renal failure (all p-values < 0.05). Infectious complications (sepsis, wound infection and abscess) all peaked between 45–65 years old, and then declined with increasing age. Conclusions We document that elderly trauma patients suffer the same complications as their younger counterparts, albeit at a different rate. More importantly, we identified a “breakpoint” of increased risk of complications and mortality at greater than 45 years of age. While the mechanisms behind these observations remain unknown, understanding their unique patterns may allow appropriate allocation of resources and focus research efforts on interventions that should improve outcomes.

Análise comparativa das características do trauma entre idosos com idade superior e inferior a 80 anos

“…The incidence of lesions to the head segment is significant, as well as fractures of extremities 12 . The mortality rate is higher than in younger individuals, especially in the presence of concomitant diseases and the need for specific treatment [12][13][14] . In a previous study we compared patients aged above and below 60 years and observed a higher incidence of severe intracranial lesions, such as subdural hematomas, cerebral contusions and subarachnoid hemorrhage in the group of patients with more advanced age 14 …”

Increasing Trauma Deaths in the United States

“…4,5 In fact, a linear relationship between advancing age and increasing mortality after injury has been described, with the oldest patients experiencing the highest mortality rates. 6,7 Significant advancements have been made in the therapy of cancer and heart disease. In particular, emphasis on these 2 leading killers has long resulted in a disproportionate allocation of research funding.…”

“…2 An increase in middle-aged and geriatric admissions to trauma centers is anticipated, 3,4 and multiple studies have shown that advanced age is associated with poor outcome after injury. 5,6 Specifically, injured patients aged 40 to 45 years reportedly have higher complication and mortality rates than younger patients. 4,5 In fact, a linear relationship between advancing age and increasing mortality after injury has been described, with the oldest patients experiencing the highest mortality rates.…”

Post-traumatic thrombo-embolic complications in polytrauma patients

“…Multiple factors, including magnitude of injury [11] and age [12], can affect the outcomes of trauma. In this context, we examined the impact of injury severity and age on the rates of TE.…”