Skip to main content

Advertisement

SpringerLink
Log in

Age and mortality after injury: is the association linear?

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Multiple studies have demonstrated a linear association between advancing age and mortality after injury. An inflection point, or an age at which outcomes begin to differ, has not been previously described. We hypothesized that the relationship between age and mortality after injury is non-linear and an inflection point exists.

Methods

We performed a retrospective cohort analysis at our urban level I center from 2007 through 2009. All patients aged 65 years and older with the admission diagnosis of injury were included. Non-parametric logistic regression was used to identify the functional form between mortality and age. Multivariate logistic regression was utilized to explore the association between age and mortality. Age 65 years was used as the reference. Significance was defined as p < 0.05.

Results

A total of 1,107 patients were included in the analysis. One-third required intensive care unit (ICU) admission and 48 % had traumatic brain injury. 229 patients (20.6 %) were 84 years of age or older. The overall mortality was 7.2 %. Our model indicates that mortality is a quadratic function of age. After controlling for confounders, age is associated with mortality with a regression coefficient of 1.08 for the linear term (p = 0.02) and a regression coefficient of −0.006 for the quadratic term (p = 0.03). The model identified 84.4 years of age as the inflection point at which mortality rates begin to decline.

Conclusions

The risk of death after injury varies linearly with age until 84 years. After 84 years of age, the mortality rates decline. These findings may reflect the varying severity of comorbidities and differences in baseline functional status in elderly trauma patients. Specifically, a proportion of our injured patient population less than 84 years old may be more frail, contributing to increased mortality after trauma, whereas a larger proportion of our injured patients over 84 years old, by virtue of reaching this advanced age, may, in fact, be less frail, contributing to less risk of death.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Department of Health & Human Services. Administration on Aging. Aging Statistics. Home Page, 9-1-2011. 2-4-2012. Ref type: electronic citation.

  2. Giannoudis PV, Harwood PJ, Court-Brown C, Pape HC. Severe and multiple trauma in older patients; incidence and mortality. Injury. 2009;40:362–7.

    Article  CAS  PubMed  Google Scholar 

  3. Taylor MD, Tracy JK, Meyer W, Pasquale M, Napolitano LM. Trauma in the elderly: intensive care unit resource use and outcome. J Trauma. 2002;53:407–14.

    Article  PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention (CDC). Causes of death by age group. Injury prevention and control: data and statistics. 9-3-2010. Ref type: electronic citation.

  5. Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am Coll Surg. 2003;196:549–55.

    Article  PubMed  Google Scholar 

  6. Jacobs DG, Plaisier BR, Barie PS, et al. Practice management guidelines for geriatric trauma: the EAST practice management guidelines work group. J Trauma. 2003;54:391–416.

    Article  PubMed  Google Scholar 

  7. Morris JA Jr, MacKenzie EJ, Damiano AM, Bass SM. Mortality in trauma patients: the interaction between host factors and severity. J Trauma. 1990;30:1476–82.

    Article  PubMed  Google Scholar 

  8. Adams SD, Cotton BA, McGuire MF, et al. Unique pattern of complications in elderly trauma patients at a level I trauma center. J Trauma Acute Care Surg. 2012;72(1):112–8.

    PubMed  Google Scholar 

  9. Bochicchio GV, Joshi M, Bochicchio K, Shih D, Meyer W, Scalea TM. Incidence and impact of risk factors in critically ill trauma patients. World J Surg. 2006;30:114–8.

    Article  PubMed  Google Scholar 

  10. Joseph B, Pandit V, Aziz H, et al. Rehabilitation after trauma; does age matter? J Surg Res. 2013;184:541–5.

    Article  PubMed  Google Scholar 

  11. Broos PL, Stappaerts KH, Rommens PM, Louette LK, Gruwez JA. Polytrauma in patients of 65 and over. Injury patterns and outcome. Int Surg. 1988;73:119–22.

    CAS  PubMed  Google Scholar 

  12. Oreskovich MR, Howard JD, Copass MK, Carrico CJ. Geriatric trauma: injury patterns and outcome. J Trauma. 1984;24:565–72.

    Article  CAS  PubMed  Google Scholar 

  13. Morris JA Jr, MacKenzie EJ, Edelstein SL. The effect of preexisting conditions on mortality in trauma patients. JAMA. 1990;263:1942–6.

    Article  PubMed  Google Scholar 

  14. DeMaria EJ, Kenney PR, Merriam MA, Casanova LA, Gann DS. Survival after trauma in geriatric patients. Ann Surg. 1987;206:738–43.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Hastie TJ, Tibshirani RJ. Generalized additive models. New York: Chapman & Hall/CRC; 1990.

    Google Scholar 

  16. Martin JT, Alkhoury F, O’Connor JA, Kyriakides TC, Bonadies JA. ‘Normal’ vital signs belie occult hypoperfusion in geriatric trauma patients. Am Surg. 2010;76:65–9.

    PubMed  Google Scholar 

  17. Demetriades D, Sava J, Alo K, et al. Old age as a criterion for trauma team activation. J Trauma. 2001;51:754–6.

    Article  CAS  PubMed  Google Scholar 

  18. Demetriades D, Karaiskakis M, Velmahos G, et al. Effect on outcome of early intensive management of geriatric trauma patients. Br J Surg. 2002;89:1319–22.

    Article  CAS  PubMed  Google Scholar 

  19. Scalea TM, Simon HM, Duncan AO, et al. Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J Trauma. 1990;30:129–34.

    Article  CAS  PubMed  Google Scholar 

  20. Friese RS, Shafi S, Gentilello LM. Pulmonary artery catheter use is associated with reduced mortality in severely injured patients: a National Trauma Data Bank analysis of 53,312 patients. Crit Care Med. 2006;34:1597–601.

    Article  PubMed  Google Scholar 

  21. Caterino JM, Valasek T, Werman HA. Identification of an age cutoff for increased mortality in patients with elderly trauma. Am J Emerg Med. 2010;28:151–8.

    Article  PubMed  Google Scholar 

  22. Joseph B, Pandit V, Sadoun M, et al. Frailty in surgery. J Trauma Acute Care Surg. 2014.

  23. Hashmi A, Ibrahim-Zada I, Rhee P, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014;76(3).

  24. Joseph B, Pandit V, Rhee P, et al. Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer? J Trauma Acute Care Surg. 2014;76:196–200.

    Article  PubMed  Google Scholar 

  25. Arhinful E, Jenkins D, Schiller HJ, Cullinane DC, Smoot DL, Zielinski MD. Outcomes of damage control laparotomy with open abdomen management in the octogenarian population. J Trauma. 2011;70:616–21.

    Article  PubMed  Google Scholar 

  26. Grossman M, Scaff DW, Miller D, Reed J 3rd, Hoey B, Anderson HL 3rd. Functional outcomes in octogenarian trauma. J Trauma. 2003;55:26–32.

    Article  PubMed  Google Scholar 

  27. Maxwell JG, Tyler BA, Maxwell BG, Brinker CC, Covington DL. Laparoscopic cholecystectomy in octogenarians. Am Surg. 1998;64:826–31.

    CAS  PubMed  Google Scholar 

  28. Milzman DP, Boulanger BR, Rodriguez A, Soderstrom CA, Mitchell KA, Magnant CM. Pre-existing disease in trauma patients: a predictor of fate independent of age and injury severity score. J Trauma. 1992;32:236–43.

    Article  CAS  PubMed  Google Scholar 

  29. MacKenzie EJ, Morris JA Jr, Edelstein SL. Effect of pre-existing disease on length of hospital stay in trauma patients. J Trauma. 1989;29:757–64.

    Article  CAS  PubMed  Google Scholar 

  30. Schuurmans H, Steverink N, Lindenberg S, Frieswijk N, Slaets JP. Old or frail: what tells us more? J Gerontol A Biol Sci Med Sci. 2004;59:M962–5.

    Article  PubMed  Google Scholar 

  31. Andela RM, Dijkstra A, Slaets JP, Sanderman R. Prevalence of frailty on clinical wards: description and implications. Int J Nurs Pract. 2010;16:14–9.

    Article  PubMed  Google Scholar 

  32. Robinson TN, Wallace JI, Wu DS, et al. Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg. 2011;213:37–42.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Fleischman RJ, Adams AL, Hedges JR, Ma OJ, Mullins RJ, Newgard CD. The optimum follow-up period for assessing mortality outcomes in injured older adults. J Am Geriatr Soc. 2010;58:1843–9.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Joseph B, Sadoun M, Aziz H, et al. Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted. Am Surg. 2014;80:43–7.

    PubMed  Google Scholar 

Download references

Conflict of interest

There are no identifiable conflicts of interest to report. R. S. Friese, J. Wynne, B. Joseph, A. Hashmi, C. Diven, V. Pandit, T. O’Keeffe, B. Zangbar, N. Kulvatunyou and P. Rhee have no financial or proprietary interest in the subject matter or materials discussed in the manuscript.

Compliance with Ethics Guidelines

This article does not contain any studies with human or animal subjects performed by any of the authors. The Institutional Review Board for the University of Arizona College of Medicine and the site review authority for the UAMC approved this study.

Author information

Authors and Affiliations

  1. Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA

    R. S. Friese, J. Wynne, B. Joseph, A. Hashmi, C. Diven, V. Pandit, T. O’Keeffe, B. Zangbar, N. Kulvatunyou & P. Rhee

Authors
  1. R. S. Friese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Wynne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Hashmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Diven
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Pandit
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. O’Keeffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B. Zangbar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. N. Kulvatunyou
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Rhee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Joseph.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Friese, R.S., Wynne, J., Joseph, B. et al. Age and mortality after injury: is the association linear?. Eur J Trauma Emerg Surg 40, 567–572 (2014). https://doi.org/10.1007/s00068-014-0380-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-014-0380-0

Keywords

Search

Navigation