Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug 8:22:45.
doi: 10.1186/s13049-014-0045-3.

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

Carsten Schoeneberg, Thomas Probst, Marc Schilling, Alexander Wegner, Bjoern Hussmann, Sven Lendemans

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

Carsten Schoeneberg et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Demographic 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.

Methods: All 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.

Results: One-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).

Conclusions: The 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Time to death in severely injured elderly patients.
Figure 2
Figure 2
Cause of death in severely injured elderly patients.
Figure 3
Figure 3
Box-plot diagram of the ISS divided into decedents and survivors.
Figure 4
Figure 4
Distribution of the infused fluid volume divided by decedents and survivors.
Figure 5
Figure 5
Mortality and RISC-score in the age-adjusted groups.
Figure 6
Figure 6
Mortality and RISC-score in the ISS-adjusted groups.
See this image and copyright information in PMC

References

    1. https://www.destatis.de/DE/Publikationen/Thematisch/Bevoelkerung/Bevoelk... Bevölkerung - Alter im Wandel - Ältere Menschen in Deutschland und der EU - Statistisches Bundesamt (Destatis).] Accessed April 2014.
    1. Sampalis JS, Nathanson R, Vaillancourt J, Nikolis A, Liberman M, Angelopoulos J, Krassakopoulos N, Longo N, Psaradellis E. Assessment of mortality in older trauma patients sustaining injuries from falls or motor vehicle collisions treated in regional level I trauma centers. Ann Surg. 2009;249:488–495. doi: 10.1097/SLA.0b013e31819a8b4f. - DOI - PubMed
    1. Goodmanson NW, Rosengart MR, Barnato AE, Sperry JL, Peitzman AB, Marshall GT. Defining geriatric trauma: When does age make a difference? Surgery. 2012;152:668–675. doi: 10.1016/j.surg.2012.08.017. - DOI - PMC - PubMed
    1. Shifflette VK, Lorenzo M, Mangram AJ, Truitt MS, Amos JD, Dunn EL. Should age be a factor to change from a level II to a level I trauma activation? J Trauma. 2010;69:88–92. doi: 10.1097/TA.0b013e3181e291e9. - DOI - PubMed
    1. Taylor MD, Tracy JK, Meyer W, Pasquale M, Napolitano LM. Trauma in the elderly: intensive care unit resource use and outcome. J Trauma. 2002;53:407–414. doi: 10.1097/00005373-200209000-00001. - DOI - PubMed