Skip to main content

Advertisement

SpringerLink
Log in

Gunshot Injuries in the Elderly: Patterns and Outcomes. A National Trauma Databank Analysis

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Trauma in the elderly (≥55 years) accounts for a significant proportion of admissions to trauma centers. Our understanding of the epidemiology and outcomes associated with penetrating injury in this age segment of the population, however, is severely limited. The aim of the present study therefore was to investigate the incidence and type of injuries sustained by elderly patients from firearms and the impact of age on outcomes.

Methods

This was a 5-year National Trauma Databank (NTDB) study. Injury demographics, mortality rates, and lengths of stay in the Intensive Care Unit (ICU) and the hospital were analyzed. Elderly patients ≥55 years old were assigned to one of three categorical strata: 55–64 years old, 65–74 years old, and ≥75 years old.

Results

During the study period, 98,242 patients were admitted for firearm-related injuries, and 3,190 (3.2%) of them were ≥55 years old. Within the elderly age segment of the population, 1,676 patients (52.5%) were 55–64 years of age, 727 (22.8%) were 65–74 years of age, and 787 (24.7%) were ≥75 years old. The incidence of severe trauma [Injury Severity Score (ISS) ≥ 16] in the elderly age strata was 43.3, 46.8, and 57.6%, respectively (p < 0.001). Patients ≥75 years old were significantly more likely than patients 55–74 years old to suffer self-inflicted injuries. The most commonly encountered injury in elderly patients was gunshot wounds to the head, which increased in a stepwise fashion with advancing age (25.8, 31.6, and 39.4% respectively; p < 0.001). The crude mortality rate in all patients sustaining gunshot wounds increased progressively with age. Within the elderly age segment, mortality ranged from 28.5% in the age stratum 55–64 years, to 55.4% in the stratum ≥75 years (adjusted p < 0.001). Intensive care unit and hospital length of stay increased with advancing age but peaked and remained stable among the elderly age groups. An admission Glasgow Coma Score (GCS) ≤ 8, an ISS ≥ 16, hypotension on admission, age, self-inflicted injury, and injury sustained by assault were factors independently associated with death in patients ≥55 years.

Conclusions

Injury from firearms is not uncommon in the elderly patient population and is primarily a result of self-inflicted gunshot wounds to the head. These patients sustain a high burden of injury and a high rate of mortality, which increases with advancing age.

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. United States Census Bureau (2008) Age groups and sex 2008. United States Census Bureau, Washington, DC

  2. Bergen G, Chen LH, Warner M et al (2008) Injury in the United States: 2007, Chartbook. National Center for Health Statistics, Hyattsville

  3. Roth BJ, Velmahos GC, Oder DB et al (2001) Penetrating trauma in patients older than 55 years: a case–control study. Injury 32:551–554

    Article  CAS  PubMed  Google Scholar 

  4. Nagy KK, Smith RF, Roberts RR et al (2000) Prognosis of penetrating trauma in elderly patients: a comparison with younger patients. J Trauma 49:190–193 discussion 193–194

    Article  CAS  PubMed  Google Scholar 

  5. Asensio JA, Trunkey DD (eds) (2008) Current therapy of trauma and surgical critical care. Mosby Elsevier, Philadelphia

  6. Centers for Disease Control and Prevention (2008) National center for injury prevention and control. Suicide. Facts at a glance. Summer, Atlanta, GA

  7. Demetriades D, Murray J, Sinz B et al (1998) Epidemiology of major trauma and trauma deaths in Los Angeles County. J Am Coll Surg 187:373–383

    Article  CAS  PubMed  Google Scholar 

  8. Taylor MD, Tracy JK, Meyer W et al (2002) Trauma in the elderly: intensive care unit resource use and outcome. J Trauma 53:407–414

    Article  PubMed  Google Scholar 

  9. Kuhne CA, Ruchholtz S, Kaiser GM et al (2005) Mortality in severely injured elderly trauma patients—when does age become a risk factor? World J Surg 29:1476–1482

    Article  PubMed  Google Scholar 

  10. Perdue PW, Watts DD, Kaufmann CR et al (1998) Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death. J Trauma 45:805–810

    Article  CAS  PubMed  Google Scholar 

  11. Ottochian M, Salim A, DuBose J et al (2009) Does age matter? The relationship between age and mortality in penetrating trauma. Injury 40:354–357

    Article  PubMed  Google Scholar 

  12. Demetriades D, Karaiskakis M, Velmahos G et al (2002) Effect on outcome of early intensive management of geriatric trauma patients. Br J Surg 89:1319–1322

    Article  CAS  PubMed  Google Scholar 

  13. Demetriades D, Sava J, Alo K et al (2001) Old age as a criterion for trauma team activation. J Trauma 51:754–756 discussion 756–757

    Article  CAS  PubMed  Google Scholar 

  14. Scalea TM, Simon HM, Duncan AO et al (1990) Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J Trauma 30:129–134 discussion 134–136

    Article  CAS  PubMed  Google Scholar 

  15. McGwin G Jr, Melton SM, May AK et al (2000) Long-term survival in the elderly after trauma. J Trauma 49:470–476

    Article  PubMed  Google Scholar 

  16. Inaba K, Goecke M, Sharkey P et al (2003) Long-term outcomes after injury in the elderly. J Trauma 54:486–491

    Article  PubMed  Google Scholar 

  17. Wagner AK, Sasser HC, Hammond FM et al (2000) Intentional traumatic brain injury: epidemiology, risk factors, and associations with injury severity and mortality. J Trauma 49:404–410

    Article  CAS  PubMed  Google Scholar 

  18. Bennett KM, Vaslef SN, Shapiro ML et al (2009) Does intent matter? The medical and societal burden of self-inflicted injury. J Trauma 67:841–847

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Trauma and Critical Care, Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles County General Hospital (LAC + USC), 1200 North State Street, IPT, C5L100, Los Angeles, CA, 90033-4525, USA

    Thomas Lustenberger, Kenji Inaba, Beat Schnüriger, Galinos Barmparas, Barbara M. Eberle, Lydia Lam, Peep Talving & Demetrios Demetriades

Authors
  1. Thomas Lustenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenji Inaba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Beat Schnüriger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Galinos Barmparas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara M. Eberle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lydia Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peep Talving
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Demetrios Demetriades
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenji Inaba.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lustenberger, T., Inaba, K., Schnüriger, B. et al. Gunshot Injuries in the Elderly: Patterns and Outcomes. A National Trauma Databank Analysis. World J Surg 35, 528–534 (2011). https://doi.org/10.1007/s00268-010-0920-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-010-0920-7

Keywords

Search

Navigation