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

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Sven Lendemans¹  Bjoern Hussmann¹  Alexander Wegner¹  Marc Schilling¹  Thomas Probst²  Carsten Schoeneberg¹ 

[1] Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany;Department of Trauma, Orthopedic, and Hand Surgery, Municial Hospital Neuss, Lukashospital GmbH, Preußenstraße 84, Neuss 41464, Germany

关键词: Severely injured;    Elderly patients;    Mortality rate;    Trauma;   

Others  :  1152086
DOI  :  10.1186/s13049-014-0045-3

 received in 2014-05-02, accepted in 2014-07-28,  发布年份 2014

【 摘 要 】

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).

Only 17.1% of patients presenting an ISS > 25 survived, suggesting that an injury of such severity is hardly survivable in the subject age group.

Predictors for mortality were: ISS > 25, GCS < 9, PTT > 32.4 seconds, prothrombin ratio < 70%, AIS head > 3, and Hb < 12 g/dl.

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.

【 授权许可】

   
2014 Schoeneberg et al.; licensee BioMed Central Ltd.

【 图 表 】

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