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
Meta-Analysis
. 2024 Sep 1;97(3):478-487.
doi: 10.1097/TA.0000000000004320.

Identifying factors predicting outcomes after major trauma in older patients: Prognostic systematic review and meta-analysis

Mayura Thilanka Iddagoda  1 , Michelle Trevenen, Claire Meaton, Christopher Etherton-Beer, Leon Flicker
Affiliations
Meta-Analysis

Identifying factors predicting outcomes after major trauma in older patients: Prognostic systematic review and meta-analysis

Mayura Thilanka Iddagoda et al. J Trauma Acute Care Surg. .

Abstract

Introduction: Trauma is the most common cause of morbidity and mortality in older people, and it is important to determine the predictors of outcomes after major trauma in older people.

Methods: MEDLINE, Embase, and Web of Science were searched, and manual search of relevant papers since 1987 to February 2023 was performed. Random-effects meta-analyses were performed. The primary outcome of interest was mortality, and secondary outcomes were medical complications, length of stay, discharge destination, readmission, and intensive care requirement.

Results: Among 6,064 studies in the search strategy, 136 studies qualified the inclusion criteria. Forty-three factors, ranging from demographics to patient factors, admission measurements, and injury factors, were identified as potential predictors. Mortality was the commonest outcome investigated, and increasing age was associated with increased risk of in-hospital mortality (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.07) along with male sex (OR, 1.40; 95% CI, 1.24-1.59). Comorbidities of heart disease (OR, 2.59; 95% CI, 1.41-4.77), renal disease (OR, 2.52; 95% CI, 1.79-3.56), respiratory disease (OR, 1.40; 95% CI, 1.09-1.81), diabetes (OR, 1.35; 95% CI, 1.03-1.77), and neurological disease (OR, 1.42; 95% CI, 0.93-2.18) were also associated with increased in-hospital mortality risk. Each point increase in the Glasgow Coma Scale lowered the risk of in-hospital mortality (OR, 0.85; 95% CI, 0.76-0.95), while each point increase in Injury Severity Score increased the risk of in-hospital mortality (OR, 1.07; 95% CI, 1.04-1.09). There were limited studies and substantial variability in secondary outcome predictors; however, medical comorbidities, frailty, and premorbid living condition appeared predictive for those outcomes.

Conclusion: This review was able to identify potential predictors for older trauma patients. The identification of these factors allows for future development of risk stratification tools for clinicians.

Level of evidence: Systematic Review and Meta-Analysis; Level III.

PubMed Disclaimer

References

    1. World Health Organization. Noncommunicable diseases country profiles 2014. 2014. Published 2014. Available at: https://www.who.int/publications/i/item/9789241507509 . Accessed February 10, 2024.
    1. Victorino GP, Chong TJ, Pal JD. Trauma in the elderly patient. Arch Surg . 2003;138(10):1093–1098.
    1. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg . 2021;88:105906.
    1. Sammy I, Lecky F, Sutton A, Leaviss J, O’Cathain A. Factors affecting mortality in older trauma patients—a systematic review and meta-analysis. Injury . 2016;47(6):1170–1183.
    1. Ahmadi S, Sarveazad A, Babahajian A, Ahmadzadeh K, Yousefifard M. Comparison of Glasgow Coma Scale and full outline of UnResponsiveness score for prediction of in-hospital mortality in traumatic brain injury patients: a systematic review and meta-analysis. Eur J Trauma Emerg Surg . 2023;49(4):1693–1706.