Predictors of Mortality in Trauma Patients Aged 80 years or Older.

ABSTRACT

The population of the United States is predicted to age dramatically over the next few decades; as such older patients will comprise an increasing proportion of the injured populations. Due to multiple comorbidities and frailty, the old and very old are at greater risk for mortality than younger patients. To identify predictors of inhospital mortality in these patients, we performed a retrospective cohort study at our Level 1 trauma center. Between April 2009 and October 2014, we identified 193 trauma patients aged 80 years and older admitted to the intensive care unit. The mean age was 86 years old (4.9) and a majority of patients were white (57%) and male (54%). Univariate analysis found Injury Severity Score (P < 0.01), initial Glasgow Coma Scale (P < 0.01), admission pH (P = <0.01), admission lactate (P < 0.01), the need for mechanical ventilation (P < 0.01), and Geriatric Trauma Outcome Score (P < 0.01) to be predictors of mortality. Multivariate analysis identified length of mechanical ventilation [odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.60-0.90, P < 0.01], admission lactate (OR = 1.74, 95% CI = 1.21-2.51, P < 0.01), and the need for mechanical ventilation (OR = 18.2, 95% CI = 3.33-99.8, P < 0.01) as independent predictors of mortality. These predictors can help guide clinical decisions and should prompt early discussion of goals of care. The association between mechanical ventilation and mortality is confounded by withdrawal of care.