Age itself or age-associated comorbidities? A nationwide analysis of outcomes of geriatric trauma

Abstract

Purpose Geriatric trauma patients present physiological challenges to care providers. A nationwide analysis was performed to evaluate the roles of age alone versus age-associated comorbidities in the morbidity and mortality of elderly patients with blunt abdominal trauma (BAT). Methods Patients with BAT registered in the National Trauma Data Bank from 2013 to 2015 were analyzed using propensity score matching (PSM) to evaluate the mortality rate, complication rate, hospital length of stay (LOS), intensive care unit (ICU) LOS and ventilator days between young (age < 65) and elderly (age ≥ 65) patients. An adjusted multivariate logistic regression (MLR) model was also used to evaluate the effect of age itself and age-associated comorbidities on mortality. Results There were 41,880 patients with BAT during the study period. In elderly patients, the injury severity score (ISS) decreased with age, but the mortality rate increased inversely (from 5.0 to 13.5%). Under a similar condition and proportion of age-associated comorbidities after a well-batched PSM analysis, elderly patients had significantly higher mortality rates (8.0% vs. 1.9%, p < 0.001), higher complication rates (35.1% vs. 30.6%, p < 0.001), longer hospital LOS (8.9 vs. 8.1 days, p < 0.001), longer ICU LOS (3.7 vs. 2.7 days, p < 0.001) and more ventilator days (1.1 vs. 0.5 days, p < 0.001) than young patients. Furthermore, the MLR analysis showed that age itself served as an independent factor for mortality (odds ratio: 1.049, 95% CI 1.043-1.055, p < 0.001), but age-associated comorbidity was not. Conclusion In patients with BAT, age itself appeared to have an independent and deleterious effect on mortality, but ageassociated comorbidity did not.

A rat model of multicompartmental traumatic injury and hemorrhagic shock induces bone marrow dysfunction and profound anemia

“…This model of polytrauma did not include common injuries such as traumatic brain injury or intra‐abdominal solid organ injury, which are not uncommon in blunt trauma. It also only included one age group of animals and did not include females; both sex and age have been shown to affect postinjury outcomes 55,56 . Future iterations of polytrauma should consider including these injuries along with females and a variety of age groups.…”

“…It also only included one age group of animals and did not include females; both sex and age have been shown to affect postinjury outcomes. 55 , 56 Future iterations of polytrauma should consider including these injuries along with females and a variety of age groups. Longer durations of study should also be investigated to understand recovery from such severe injury.…”

Diagnostic Value of sIL-2R, TNF-α and PCT for Sepsis Infection in Patients With Closed Abdominal Injury Complicated With Severe Multiple Abdominal Injuries

“…The accompanying multiple injuries may conceal the actual physical signs of patients, thus increasing the difficulty of clinical diagnosis. In the case of closed abdominal injury combined with multiple systemic injuries, the patients' injuries are severe and complex, including shock, sepsis, coma, dyspnea, and other symptoms in the early stage, which makes the diagnosis and treatment more difficult and leads to higher mortality (4).…”