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Mortality in Severely Injured Elderly Trauma Patients—When Does Age Become a Risk Factor?

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Abstract

Age is a well-known risk factor in trauma patients. The aim of the present study was to define the age-dependent cut-off for increasing mortality in multiple injured patients. Pre-existing medical conditions in older age and impaired age-dependent physiologic reserve contributing to a worse outcome in multiple injured elderly patients are discussed as reasons for increased mortality. A retrospective clinical study of a statewide trauma data set from 1993 through 2000 included 5375 patients with an Injury Severity Score (ISS) ≥ 16 who were stratified by age. The ISS and Abbreviated Injury Score (AIS) quantified the injury severity. Outcome measures were mortality, shock, multiple organ failure, and severe head injury. Mortality in this series increased beginning at age 56 years, and that increase was independent of the ISS. The mortality rate increased from 7.3% (patients 46–55 years of age) to 13.0% (patients ages 56–65 years) in patients with ISS 16–24; from 23.8% to 32.1% in those with ISS 25–50; and from 62.2% to 82.1% in those with ISS 51–75 (P ≤ 0.05). Severe traumatic brain injury (sTBI) was the most frequent cause of death, with a significant peak in patients older than 75 years. The incidence of lethal multiple organ failure increased significantly beginning at age 56 years (P ≤ 0.05), but it showed no further increase in patients aged 76 years or older. In contrast, the incidence of lethal shock showed a significant increase from age 76 years (P ≤ 0.05), but not at age 56 years. However, from age 56 years, mortality increased significantly in patients who sustained multiple trauma—an increase that was independent of trauma severity.

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References

  1. Demetriades D, Sava J, Alo K. Old age as a criterion for trauma team activation. J. Trauma 2001;51:754–757

    PubMed  CAS  Google Scholar 

  2. United States Bureau of the Census. Current Population Reports, Special Studies, P23–190, http://www.census.gov/prod/1/pop/p23–190/p23–190.html

  3. Nagy KK, Smith RF., Roberts RR. Prognosis of penetrating trauma in elderly patients: a comparison with younger patients. J Trauma 2000;49:190–194

    PubMed  CAS  Google Scholar 

  4. Shorr RM, Rodriguez A, Indeck MC. Blunt chest trauma in the elderly. J Trauma 1989;29:234–237

    PubMed  CAS  Google Scholar 

  5. McMahon DJ, Schwab CW, Kauder D. Comorbidity and the elderly trauma patient. World J Surg. 1996;20:1113–1120

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  7. Grossman MD, Miller D, Scaff DW. When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma. J Trauma 2002;52:242–246

    PubMed  Google Scholar 

  8. Vollmer DG. Age and outcome following traumatic coma: why do older patients fare worse? J Neurosurg. 1991;75:37–49

    Google Scholar 

  9. Battistella FD, Din AM, Perez L. Trauma patients 75 years and older: long term follow-up results justify aggressive management. J. Trauma 1998;44:618–623

    PubMed  CAS  Google Scholar 

  10. Champion HR, Copes WS, Sacco WJ. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma 1990;30:1356–1365

    PubMed  CAS  Google Scholar 

  11. Morris JAJ, McKenzie EJ, Damiano AM. Mortality in trauma patients: the interaction between host factors and severity. J Trauma 1990;30:1476–1482

    PubMed  Google Scholar 

  12. Das Traumaregister der Deutschen Gesellschaft für Unfallchirurgie. Arbeitsgemeinschaft “Scoring” der Deutschen Gesellschaft für Unfallchirurgie (DGU). Unfallchirurg 1994; 97:230–237

    Google Scholar 

  13. Tornetta P, Mostafavi H, Riina J. Morbidity, mortality in elderly trauma patients. J Trauma 1999;46:702–706

    PubMed  Google Scholar 

  14. Lonner J, Koval K. Polytrauma in the elderly. Clin. Orthop. 1995;318:136–143

    PubMed  Google Scholar 

  15. van der Sluis CK, Klasen HJ, Eisma WH. Major trauma in young and old: what is the difference? J. Trauma 1996;40:78–82

    PubMed  Google Scholar 

  16. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356–359

    Article  PubMed  Google Scholar 

  17. Oldridge NB, Stump TE, Nothwehr FK. Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults. J. Clin. Epidemiol. 2001;54:928–934

    Article  PubMed  CAS  Google Scholar 

  18. Tepas JJ, Veldenz HC, Lottenberg L. Elderly Injury: a profile of trauma experience in the sunshine (retirement) state. J. Trauma 2000;48:581–586

    PubMed  Google Scholar 

  19. Yang XS, Willems JL, Pardaens J. Acute myocardial infarction in the very elderly. A comparison with younger age group. Acta Cardiol. 1987;42:59–68

    PubMed  CAS  Google Scholar 

  20. Olivetti G, Melissari M, Capasso JM. Cardiomyopathy of the aging human heart: myocyte loss, reactive cellular hypertrophy. Circ. Res. 1991;68:1560–1568

    PubMed  CAS  Google Scholar 

  21. Devlin W, Cragg D, Jacks M. Comparision of outcome in patients with acute myocardial infarction aged > 75 years with that in younger patients. Am. J. Cardiol. 1995;15:573–576

    Google Scholar 

  22. Lew A, Hod H, Cercek B. Mortality and morbidity rates of patients older and younger than 75 years with acute myocardial infarction treated with intravenous streptokinase. Am. J. Cardiol. 1987;59:1–5

    PubMed  CAS  Google Scholar 

  23. Marxheimer H. Subdural hematomas in victims with and without cerebral contusions— comparison of two types of head injuries. Rechtsmedizin 1998;9:14–20

    Google Scholar 

  24. Kuhne CA, Homann M, Ose C. Emergency room patients. Unfallchirurg 2003;106:380–386

    PubMed  CAS  Google Scholar 

  25. Santora TA, Schinco MA, Trooskin SZ. Management of trauma in the elderly patient. Surg. Clin. North Am. 1994;74:278–283

    Google Scholar 

  26. Scalea TM, Simon HM, Duncan AO. Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J. Trauma 1990;30:129–136

    PubMed  CAS  Google Scholar 

  27. Jacobs DG, Plaisier BR, Barie PS, et al. and the EAST Practice Management Guidelines Work Group. Practice management guidelines for geriatric trauma: the EAST Practice Management Guidelines Work Group. J. Trauma 2003;54:391–416

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma Surgery, University Hospital Essen, Essen, Germany

    Christian A. Kuhne MD, Steffen Ruchholtz MD & Dieter Nast-Kolb MD (Working Group on Multiple Trauma of the German Society of Trauma)

  2. Department of General Surgery and Transplantation, University Hospital Essen, Essen, Germany

    Gernot M. Kaiser MD

Authors
  1. Christian A. Kuhne MD
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  2. Steffen Ruchholtz MD
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  3. Gernot M. Kaiser MD
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  4. Dieter Nast-Kolb MD
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Corresponding author

Correspondence to Christian A. Kuhne MD.

Additional information

Members of the Working Group “Multiple Trauma” of the German Society of Trauma: B. Bouillon (Köln), S. Eich (München), K.G. Kanz (München), C.A. Kühne (Essen), C. Lackner (München), R. Lefering (Köln), U. Lewan (Essen), W. Mutschler (München), D.Nast-Kolb (Essen), E. Neugebauer (Köln), , H.J. Oestern (Celle), T. Paffrath (Köln), H.C. Pape (Hannover), N. Pirente (Köln), M. Raum (Köln), G. Rieger (Celle), D. Rixen (Köln), S. Ruchholtz (Essen), L. Schlosser (Köln), C. Strohecker (Hannover), C. Waydhas (Essen), B. Zintl (München). Participating hospitals: Zentralklinikum Augsburg, Kreiskrankenhaus Bad Hersfeld, Charité - Campus Virchow-Klinikum Berlin, Martin-Luther-Krankenhaus Berlin, Klinikum Berlin-Buch, BG-Unfallklinik Berlin-Mahrzahn, Krankenanstalten Gilead Bielefeld, BG-Klinik Bochum Bergmannsheil Knappschaftskrankenhaus der Ruhr-Universität Bochum, Friedrich-Wilhelms-Universität Bonn, Zentralkrankenhaus Sankt-Jürgen-Straße Bremen, Zentralkrankenhaus Bremen-Ost, Klinikum Bremerhaven-Reinkenheide, Allgemeines Krankenhaus Celle, Klinikum Chemnitz, Klinikum Dessau, Klinikum Lippe-Detmold, Krankenhaus Dresden-Neustadt, Technische Universität Dresden, Krankenhaus Dresden-Friedrichstadt, Heinrich-Heine-Universität Düsseldorf, Klinikum Erfurt, Kreiskrankenhaus Eschwege, Universitätsklinikum Essen, Evang. Krankenhaus Lutherhaus Essen, BG Unfallklinik Frankfurt / Main, Universitätsklinik Frankfurt / Main, Klinikum Frankfurt / Oder, Klinikum Fürth, Johanniter-Krankenhaus Geesthacht, Städtisches Klinikum Görlitz, Klinik an Eichert Göppingen, Georg-August-Universität Göttingen, Universität Graz (Österreich), Allg. Unfallversicherungsanstalt Graz (Österreich), Kreiskrankenhaus Grevenbroich, Universitätsklinik Groningen (Niederlande), Kreiskrankenhaus Gummersbach, BG-Unfallkrankenhaus Hamburg, Kreiskrankenhaus Hameln, Medizinische Hochschule Hannover, Krankenhaus Hannover-Nordstadt, Friederikenstift Hannover, Ev. Krankenhaus Hattingen, Orthopäd. Universitätsklinik Heidelberg, St. Bernward Krankenhaus Hildesheim, Universität des Saarlandes Homburg / Saar, Waldviertel Klinikum Horn (Österreich), LKH Judenburg-Knittelfeld (Österreich), Städt. Klinikum Karlsruhe, Christian-Albrechts-Universität Kiel, Chirurgischer Lehrstuhl der Universität zu Köln, Städt. Klinikum Köln-Merheim, Allg. öff. Krankenhaus Krems/Donau (Österreich), Städt. Klinikum St. Georg Leipzig Universität Leipzig, Ev. Krankenhaus Lengerich, Allg. öffentl. Krankenhaus Linz (Österreich), Ev. Krankenhaus Lippstadt, Universitätsklinikum Lübeck, BG Unfallklinik Ludwigshafen, St.-Marien-Hospital Lünen, Krankenhaus Altstadt, Städt. Klinikum Magdeburg Otto-von-Guericke-Universität Magdeburg, Johannes-Gutenberg-Universität Mainz, Universitätsklinikum Mannheim, Universität Marburg, Klinikum Minden, Krankenhaus Maria Hilf Mönchengladbach, Klinikum Großhadern der LMU München, Klinikum Innenstadt der LMU München, Städt. Krankenhaus München-Harlaching, Westfälische Wilhelms-Universität Münster, BG-Unfallklinik Murnau, Lukaskrankenhaus der Städt. Kliniken Neuss, Marienhospital Osnabrück, Vogtland Klinikum Plauen, Klinikum Remscheid, Klinikum Rosenheim, Sana-Krankenhaus Rügen, St. Johanns-Spital - Landeskrankenhaus Salzburg (Österr.), Diakonissenkrankenhaus Schwäbisch Hall, Kreiskrankenhaus Soltau, Johanniter-Krankenhaus der Altmark Stendal, Kreiskrankenhaus Traunstein, BG-Unfallklinik Tübingen, Bundeswehrkrankenhaus Ulm, Universitätsklinik Ulm, Klinikum der Stadt Villingen-Schwenningen, Klinikum Weiden / Opfz., Asklepios Kreiskrankenhaus Weißenfels, Donauspital Wien (Österreich), Ferdinand-Sauerbruch-Klinikum Wuppertal, Julius-Maximilians-Universität Würzburg, Universitätsspital ETH Zürich, (Schweiz) Rettungsstelle Zusmarshausen

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Kuhne, C.A., Ruchholtz, S., Kaiser, G.M. et al. Mortality in Severely Injured Elderly Trauma Patients—When Does Age Become a Risk Factor?. World J. Surg. 29, 1476–1482 (2005). https://doi.org/10.1007/s00268-005-7796-y

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