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. 2012 Jan;72(1):112-8.
doi: 10.1097/TA.0b013e318241f073.

Unique pattern of complications in elderly trauma patients at a Level I trauma center

Sasha D Adams  1 , Bryan A Cotton, Mary F McGuire, Edmundo Dipasupil, Jeanette M Podbielski, Adrian Zaharia, Drue N Ware, Brijesh S Gill, Rondel Albarado, Rosemary A Kozar, James R Duke, Philip R Adams, Carmel B Dyer, John B Holcomb
Affiliations

Unique pattern of complications in elderly trauma patients at a Level I trauma center

Sasha D Adams et al. J Trauma Acute Care Surg. 2012 Jan.

Abstract

Background: Trauma centers are caring for increased proportions of elderly patients. Although age and Injury Severity Score are independently associated with mortality, trauma centers were originally designed to care for seriously injured patients without age-specific guidelines. We hypothesized that elderly patients would have different complication patterns than their younger counterparts.

Methods: The trauma registry of an American College of Surgeons -verified Level I trauma center was queried for all patients older than 14 years admitted between January 2005 and December 2008. Mechanism, mortality, and complications were evaluated after dividing patients into eight age groups.

Results: Of the 15,223 patients, 13% were elderly (≥65), and 86% were injured via a blunt mechanism. Increasing age correlated with fatality (all Injury Severity Scores), end-organ failure, and thromboembolic complications (deep venous thrombosis and coagulopathy). Analysis revealed a significant breakpoint at 45 years of age for mortality, decubitus ulcer, and renal failure (all p values <0.05). Infectious complications (sepsis, wound infection, and abscess) all peaked between 45 years and 65 years and then declined with increasing age.

Conclusions: We document that elderly trauma patients suffer the same complications as their younger counterparts, albeit at a different rate. More importantly, we identified a "breakpoint" of increased risk of complications and mortality at greater than 45 years. Although the mechanisms behind these observations remain unknown, understanding their unique patterns may allow appropriate allocation of resources and focus research efforts on interventions that should improve outcomes.

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Figures

Figure 1
Figure 1. Annual Elderly Admissions
Percentage of admissions ≥ 65 years old, including all ISS groups, separated by year, noting significant increase of 2.7% from 2005 to 2008. * p< 0.001.
Figure 2
Figure 2. Severity of Injury at Admission
Graph comparing ISS scores of admissions to Memorial Hermann Hospital (MHH) versus those recorded in the National Trauma Data Bank (NTDB), stratified by ISS group. Significantly lower percentage of MHH admissions in the 0–8 ISS group versus NTDB; significantly higher percentage of admissions in the 9–15, 16–24 and ≥ 25 ISS groups at MHH versus NTDB. All p values < 0.001.
Figure 3
Figure 3. Median Length of Stay by ISS and Age
Relationship between age and median length of hospital stay, stratified by ISS scores: 0–15, 16–24 and ≥ 25. Age groups combined from 15–44 years due to lack of variation: ISS 0–15 (3, 3 and 3), ISS 16–24 (5, 6 and 6) and ISS ≥25 (9, 10 and 10). Significant increase in LOS from age 65–74 to 75–84 for 0–15 ISS group. Significant decrease in LOS between ages 65–74 to 75–84 for 16–24 and ≥ 25 ISS group. All * p < 0.05.
Figure 4
Figure 4. Fatality Rate by ISS/Age
Relationship between age and case fatality rate, stratified by ISS groups: 0–15, 16–24 and ≥ 25. Age groups were combined from 15–44 years due to lack of variation: ISS 0–15 (0.2, 0.2 and 0.4), ISS 16–24 (2, 2 and 1) and ISS ≥25 (23, 25 and 26). Significant increase in fatality from age 15–44 to 45–54, and 65–74 to 75–84, within ISS 16–24. Significant increased in mortality from 45–54 to 55–64, and 65–74 to 75–84 within ISS 0–15. No significant differences between individual age groups for ISS ≥ 25. All * p < 0.05.
Figure 5
Figure 5. End-organ complications
Relationship between age and end organ complications, including integumentary complications (decubiti skin ulcers), renal failure, pulmonary complications (ARDS, pleural effusion, pulmonary edema, respiratory failure), and cardiac complications (arrhythmia, congestive heart failure, cardiac arrest, tamponade, myocardial infarction). *p < 0.01.
Figure 6
Figure 6. Coagulation complications
Relationship between age and thrombo-embolic and coagulation complications, including hypocoagulable state, DVT, PE and stroke. * p < 0.05
Figure 7
Figure 7. Infectious complications
Relationship between age and infectious complications, including pneumonia, sepsis/shock (septicemia, shock, SIRS), surgical site infection, deep-space infections and intra-abdominal infection. * p < 0.05
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References

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