Abstract
BackgroundWith an aging population, the number of elderly individuals exposed to traumatic injuries is increasing. The elderly age criterion for traumatic injuries has been inconsistent in the literature. This study aimed at specifying the elderly age criterion when the traumatic mortality rate increases.MethodsThis is a multicenter retrospective cohort study that was conducted utilizing the data from the Emergency Department-based Injury In-depth Surveillance Registry of the Korea Disease Control and Prevention Agency, collected between January 2014 and December 2018 from 23 emergency departments. The outcome variable was in-hospital mortality. Multivariable logistic regression analysis was used to calculate the adjusted mortality rate for each age group. By using the shape-restricted regression splines method, the relationship between age and adjusted traumatic mortality was plotted and the point where the gradient of the graph had the greatest variation was calculated.ResultsA total of 637,491 adult trauma patients were included. The number of in-hospital deaths was 6504 (1.0%). The age at which mortality increased the most was 65.06 years old. The adjusted odds ratio for the in-hospital mortality rate with age in the ≤ 64-year-old subgroup was 1.038 (95% confidence interval (CI) 1.032–1.044) and in the ≥ 65-year-old subgroup was 1.059 (95% CI 1.050–1.068). The adjusted odds ratio for in-hospital mortality in the ≥ 65-year-old compared to the ≤ 64-year-old subgroup was 4.585 (95% CI 4.158–5.055, p < 0.001).ConclusionsThis study found that the in-hospital mortality rate rose with increasing age and that the increase was the most rapid from the age of 65 years. We propose to define the elderly age criterion for traumatic injuries as ≥ 65 years of age.
Highlights
With an aging population, the number of elderly individuals exposed to traumatic injuries is increasing
During the study period, total 1,391,908 injured patients were treated in the emergency departments (ED) which were participating in the Emergency Department-based Injury In-depth Surveillance (EDIIS)
An increase in age was found to be independently associated with an increase in in-hospital mortality (Adjusted odds ratio (OR) (AOR) = 1.050, 95% confidence interval (CI) 1.047– 1.053, p < 0.001)
Summary
The number of elderly individuals exposed to traumatic injuries is increasing. The hospital to which the patient will be transferred is determined based on the field trauma triage guidelines, which encompass the mechanism of injury and low systolic blood pressure [2,3,4,5] Since these triage guidelines were developed using data containing the data from large number of young patients, it has been shown that the elderly are. The elderly trauma patient group had a higher rate of complications and in-hospital mortality than the younger patient group, the activation rate of the trauma team was lower [9] This age group has a high frequency of underlying comorbidities and medication use including anticoagulants, which are likely to adversely affect the prognosis. According to a study by Hollis et al [10], 75.4% of trauma patients > 65 years of age have various underlying diseases, which was shown to be an independent predictor of mortality in these patients with an injury severity score (ISS) of ≤ 24 points
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