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

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.

Injury patterns among various age and gender groups of trauma patients in southern Iran

“…Various authors have emphasized such a shift in injury mechanism across age-gender groups. [ 28 , 29 ]…”

Assessment of Severity and Prognosis of Polytrauma Outcome: the Current State of the Problem (Review)

“…Certain components of "the lethal triad" such as acidosis with blood рН below 7.2 [43], hypothermia below 35°С [44,53,54] or hypocoagulation [55][56][57][58] are also independent risk factors for unfavorable outcome. Hypothermia is associated with such polytrauma death predictors as blood loss, acidosis and coagulopathy [59].…”

“…According to some data, the threshold age when mortality among the injured starts to increase significantly is 55 years [13] or 60 years (mortality 41%) [42,84], other findings state the age of 65 years (mortality 31-50%) [36,85,86] or 75 years (mortality 57%) [57]. In patients with combined trauma over 65 years of age, systemic complications and death occur significantly more often even during the period of relative stability of their state [26].…”

Does County-Level Medical Centre Policy Influence the Health Outcomes of Patients with Trauma Transported by the Emergency Medical Service System? An Integrated Emergency Model in Rural China

“…This approach has significantly improved the survival rate of EMS patients with trauma [8]. Since the establishment of a comprehensive trauma centre in 1969, the number of traffic accident deaths in Germany has dropped from more than 20,000 in 1970 to 4000 in 2011 [9]. In view of the substantial increase in the incidence and mortality rates of trauma in China, hospitals must integrate multidisciplinary collaborations such as pre-hospital, emergency, orthopaedics, neurosurgery, and critical care, to provide comprehensive treatments.…”