Outcomes in geriatric genitourinary trauma

Abstract

Background: Geriatric trauma patients (GTPs) are the fastest growing segment of patients admitted to trauma centers. We examined the characteristics and outcomes of genitourinary (GU) trauma sustained by GTPs compared with nongeriatric trauma patients (NGTPs).

Study design: The National Trauma Data Bank v8.0 was searched by ICD-9 CM codes for GU injuries in GTPs 65 years or older compared with NGTPs aged 18 to 64 years. The incidence of GU trauma, mechanism of injury, Injury Severity Score (ISS), surgical intervention, pre-existing comorbidities, hospital complications, discharge disposition, and mortality were analyzed. Chi-square test was used to compare the distribution for categorical variables and t-test was used to compare means of continuous variables between GTPs and NGTPs.

Results: Of the 9,470 patients with GU trauma, 852 patients (9.0%) were 65 years old or older, and 8,618 patients (91.0%) were 18 to 64 years. GTPs were more likely to sustain injury to the bladder or urethra (28.9% vs 20.5% p < 0.001), and less likely to the penis (0.5% vs 3.4% p < 0.001) and scrotum or testes (1.5% vs 7.7% p < 0.001). Rates of injury to the kidney (67.5% vs 65.9%) were similar. GTPs more commonly sustained blunt trauma (92.8% vs 74.4% p < 0.0001). Although the mean Injury Severity Scores for GTPs and NGTPs were similar (17.7 vs 18.1), GTPs were more commonly admitted to the ICU (41.8% vs 31.6% p < 0.001) and had a longer ICU stay (6.6 vs 5.7 days p = 0.02). Renal embolization, nephrectomy, and nonoperative management of renal injuries were similar in both cohorts. GTPs had significantly more comorbidities and hospital complications. The mortality rate was significantly higher for GTPs (18.5% vs 9.9%, p < 0.0001).

Conclusions: GTPs sustain a significant number of GU injuries. Penetrating GU injuries are less common in GTPs. Although GTPs and NGTPs had similar mean Injury Severity Scores, GTPs had more ICU admissions, longer ICU stays, and twice the mortality rate when compared with NGTPs.