Opportunities for improved trauma care of the elderly - a single center analysis of 2090 severely injured patients

Abstract

Purpose: Western trauma centers are increasingly confronted with elderly trauma patients in parallel to an increase of the elderly population. The purpose of this study was to identify shortcomings and opportunities for improvement in the treatment of elderly trauma patients.

Materials and methods: Retrospective analysis of a prospectively collected single-center trauma database. Patients were grouped according to age and analyzed using univariate and multivariate analysis.

Results: 158 patients (7.6%) were older than 75 years, and 604 patients (28.9%) were between 50 and 75 years. Although comparable with respect to injury severity (injury severity score (ISS) 29-33) and age-adjusted Acute Physiologic and Chronic Health Evaluation (APACHE) score, there was a significant increase in mortality beyond the age of 50 (>75 years: 63.9%), with age being an independent predictor of mortality. Despite a similar rate and severity of head injuries (affecting 71% of all patients), mortality of head injuries was highest in patients >75 years (70.2%), accounting for the increased mortality in this group. Patients >75 years old were less likely to undergo craniotomy, and withdrawal of medical support occurred five times more frequently. Surviving patients ≥50 years required shorter ICU care than patients below 50 years (7.8 vs. 12.4 days).

Conclusions: With increasing life expectancy and sustained independence, elderly trauma patients have become a regular occurrence in trauma services. Despite comparable injury severity and physiologic status upon admission, these patients suffer from disproportionately high mortality rates. Closed head injuries account for the majority of fatalities, regardless of the extent of therapeutic measures applied.