Clinical analysis of severe trauma in the elderly / 中华老年医学杂志

ABSTRACT

Objective To evaluate the causes and prognosis of severe trauma in the elderly.Methods The 168 patients in elderly group (aged 60 to 91 years), 517 in middle-aged group (aged 36to 59 years) and 405 in young group (aged 18 to 35 years) were evaluated using an abbreviated injury scale (AIS2005) and injury severity score (ISS). All patients with ISS ≥ 16 were selected during a seven-year period. The injury severity, injury site number, cause of injury, injury site, emergency operation, diseases before injury, secondary infection after injury, development of multiple organ dysfunction, number of patients with Intensive Care Unit (ICU) stay, length of stay in ICU and prognosis were compared among three groups. Results The main cause of injury was accident (64patients, 38.1%), followed by traffic accident (63 patients, 37.5%) in elderly group. The traffic accident was major cause of injury in middle-aged and young group (246 patients, 47.6%; 153patients, 37.8%, respectively), followed by fall from high places (128 patients, 24.8%; 102 patients, 25.2%, respectively). The main injury sites were head and chest in elderly, middle-aged and young group (155 patients, 92.3%; 411 patients, 79.5%; 321 patients, 79.3%, respectively).There were significant differences among three groups in injury site number, emergency operation,pre-injury diseases, secondary infection after injury, number of patients with ICU stay and length of stay in ICU (F=8. 299, P＜0.01; x2= 14.88, P=0.001; x2=254.6, P＜0.01; x2=10. 54, P=0. 005; x2 = 15.62, P＜0.01; F= 5.760, P= 0.005, respectively ). In spite of injury severity (F=2.950, P= 0.053), there were significant differences between elderly group and middle-aged or young group (t=2.325, P=0.021; t=2.128, P=0.034, respectively). The incidence of multiple organ dysfunction had no significant difference among the three groups (x2 = 1.142, P= 0.565). The cure rate and unhealed automatically discharged patients had significant differences (x2 = 13.77, P= 0. 001;x2 =6.025, P= 0.049, respectively). The mortalities were similar (x2 = 1.397, P= 0.497). The leading cause of death among three groups was a serious head injury. Conclusions For elderly patients, it is important to reduce accidental injuries and traffic accidents, to improve the cure rate,and to reduce the unhealed and mortality rate.