Is there any difference in the outcome of geriatric and non-geriatric severely injured patients? – A seven-year, retrospective, observational cohort study with matched-pair analysis

Abstract

Background: The aging population has a tremendous impact on health care. Geriatric trauma is expected to increase due to the lifestyle and activity of the aging population and will be one of the major future challenges in health care. Therefore, the aim of this study was to investigate differences between polytraumatized geriatric and non-geriatric patients regarding 1) mortality, 2) length of stay, and 3) complications with a matched pair analysis. Methods: We included patients older than 17 years with an Injury Severity Score (ISS) of 16 or more admitted to our level 1 trauma center between January 2008 and December 2015. The cohort was stratified into two groups (age < 70 years “non-geriatric”, age ≥ 70 years “geriatric”). One-to-one matching was performed based on gender, ISS, mechanism of injury (penetrating/blunt), Glasgow Coma Scale (GCS), base excess, and the presence of coagulopathy (INR ≥ 1.4). Outcome was compared using the paired t-test and McNemar-test. Results: A total of 1457 patients with a mean age of 62 (± 21) years were identified. There were 1022 male (72%) and 435 female patients. Three hundred forty six patients (24%) were older than 70 years. Matching resulted in 57 pairs. 1) Mortality (25% vs 32% respectively; p = 0.219) as well as 2) length of stay (12.5 (± 13.3) days vs 11.8 (± 11.8) days respectively, p = 0.754) were comparable between geriatric and non-geriatric polytraumatized patients. 3) The complication rate (34% vs. 56%, p = 0.031) was significantly higher in geriatric patients. Conclusion: Despite significantly higher complication rates amongst the geriatric trauma patients, there were no significant differences regarding mortality and length of stay in this matched pair analysis – indicating the possibility of similar outcome in geriatric polytraumatized patients receiving optimal care.

A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

“…Overall, our findings match well with previous studies that were performed at a single large level one Trauma center in the TraumaNetzwerk DGU ® : these studies showed very similar trends concerning admissions, injury patterns, and outcome [ 21 , 49 ].…”

What’s new in trauma 2020

“…Furthermore, from the data presented by the author, at the time of admission, the elderly patients have higher systolic blood pressure (133/125) and lower base excess (-4.1/-3.6), but the presence of coagulopathy (INR> 1.4) seems with a higher rate (30.2%/20.3%). 24 Unfortunately, the authors did not follow up the elderly trauma patients for the final outcomes of 1 year or 3 years after being discharged from the hospital. Previous studies have found that patients with sepsis, especially the elderly patients, have a third peak in mortality within one year after discharge.…”