Mortality in severely injured elderly patients: a retrospective analysis of a German level 1 trauma center (2002-2011).

Carsten Schoeneberg,Alexander Wegner,Marc Schilling,Thomas Probst,Sven Lendemans,Bjoern Hussmann

doi:10.1186/s13049-014-0045-3

Carsten Schoeneberg, Alexander Wegner + Show 4 more

Open Access

https://doi.org/10.1186/s13049-014-0045-3

Copy DOI

Abstract

BackgroundDemographic change is expected to result in an increase in cases of severely injured elderly patients. To determine special considerations in treatment and outcome, patients aged 75 years and older were studied.MethodsAll patients in the included age group with an Injury Severity Score (ISS) ≥ 16 upon primary admission to hospital between July 2002 and December 2011 were included in this mortality analysis. The data used for this study was gained partly from data submitted to the German Trauma Register and partly from patients’ hospital records. A comparison between survivors and decedents was performed, as well as age-adjusted and ISS-adjusted analyses. The odds ratio and relative risk were used to determine predictors for mortality.ResultsOne-hundred eight patients met the inclusion criteria. The overall mortality proportion was 57.4%. The decedents were more severely injured (ISS 26 vs. 20, p < 0.001) and suffered more severe head traumas (GCS 4 vs. 12, p < 0.001; AIS head 5 vs. 4, p = 0.006). No differences were found in vital parameters measured at the accident scene or trauma room. Decedents had deranged coagulation with a prolonged PTT (41.1 sec vs. 27.6 sec, p = 0.008) and reduced prothrombin ratio (66.5% vs. 82.8%, p = 0.016).Only 17.1% of patients presenting an ISS > 25 survived, suggesting that an injury of such severity is hardly survivable in the subject age group.Predictors for mortality were: ISS > 25, GCS < 9, PTT > 32.4 seconds, prothrombin ratio < 70%, AIS head > 3, and Hb < 12 g/dl.ConclusionsThe treatment of severely injured elderly patients is challenging. The most common cause of accident is falling from less than 3 m with head injuries being determinant. We identified deranged coagulopathy as an important predictor for mortality, suggesting rapid normalization of coagulation might be a key to reducing mortality.

Highlights

Demographic change is expected to result in an increase in cases of severely injured elderly patients
Shifflette et al suggested that all patients aged more than 60 years with multiple injuries and/or significant mechanisms of injury should be transferred to a level 1 trauma center
General results In the observation period, 2,304 patients were admitted to the trauma room

Summary

Introduction

Demographic change is expected to result in an increase in cases of severely injured elderly patients. No other country in the European Union has such a high rate of elderly [1] This demographic trend is a challenge for internists. In an American study, the mortality rate of elderly trauma patients increased 3- to 5-fold after adjusting for injury severity [2]. Shifflette et al suggested that all patients aged more than 60 years with multiple injuries and/or significant mechanisms of injury should be transferred to a level 1 trauma center. They found a three-fold increase in morbidity and a five-fold increase in mortality in elderly patients with an ISS between 0 and 15 [4]

Objectives

Methods

Results