Nagy K K, Smith R F, Roberts R R, Joseph K T, An G C, Bokhari F, Barrett J
Department of Trauma, Cook County Hospital, Chicago, Illinois, USA.
J Trauma. 2000 Aug;49(2):190-3; discussion 193-4. doi: 10.1097/00005373-200008000-00003.
It has previously been shown that elderly patients have a worse prognosis than their younger counterparts after sustaining blunt trauma. This is due in part to a higher incidence of comorbid conditions as well as less physiologic reserve in an elderly population sustaining largely blunt trauma. We compared the outcome after penetrating trauma in elderly patients to matched "younger" patients to determine whether they had a similarly poor prognosis.
Elderly patients (> or = 65 years) were identified from our trauma registry. Sex, mechanism of injury, and Abbreviated Injury Score/Injury Severity Score were determined from the registry. Patients presenting with traumatic arrest were excluded. The registry was then searched for patients aged 15 to 40 years with the same sex, mechanism of injury, and Abbreviated Injury Score in each region. A chart review was then performed to determine additional details of their hospital stay. The two groups were then compared using Student's t test and Fisher's exact chi2 test, as appropriate.
Eighty-five elderly patients (OLD group) were admitted with penetrating trauma between 1983 and 1998. They were compared with 85 matched young patients (YOUNG group). Each group included 66 male and 19 female patients. In each group, gunshot wounds occurred in 45.9%, stab wounds in 52.9%, and shotgun wounds in 1.2% of patients. The average Injury Severity Score in each group was 5.5 +/- 5.6 (range, 1-29) and the regional Abbreviated Injury Scores were likewise equal in both groups. The OLD patients had an average hospital stay of 6.9 +/- 9.1 days compared with 4.3 +/- 5.7 days in the YOUNG patients (p < 0.05). Twenty-seven OLD patients spent 7.3 +/- 9.2 days in the intensive care unit compared with 19 YOUNG patients who stayed 3.4 +/- 3.2 days (p < .05). A total of 91 comorbidities were identified in 58 OLD patients compared with 18 in 15 YOUNG patients (p < .0001). Eighty-six invasive procedures were performed in the OLD group compared with 96 in the YOUNG group (p = not significant). Nineteen OLD patients (22.3%) and 15 YOUNG patients (17.6%) suffered one or more complications, including death (p = not significant). A total of 91% of surviving OLD patients were discharged to home compared with 100% of surviving YOUNG patients (p < .01).
Elderly patients who sustain penetrating trauma have more comorbidities than their younger counterparts. This may account for their longer hospital stay and lesser ability to be discharged home. These patients do not have an increased complication rate and should continue to be managed aggressively.
此前研究表明，老年患者在遭受钝性创伤后的预后比年轻患者更差。部分原因是老年人群中合并症发生率较高，且在遭受主要为钝性创伤时生理储备较少。我们比较了老年患者与匹配的“年轻”患者穿透性创伤后的结局，以确定他们是否有同样差的预后。
从我们的创伤登记处识别出老年患者（≥65岁）。从登记处确定性别、损伤机制以及简明损伤评分/损伤严重程度评分。排除出现创伤性心跳骤停的患者。然后在登记处搜索15至40岁、性别相同、损伤机制相同且各区域简明损伤评分相同的患者。随后进行病历审查以确定他们住院期间的其他详细情况。然后根据情况使用学生t检验和费舍尔精确卡方检验对两组进行比较。
1983年至1998年间，85例老年患者（老年组）因穿透性创伤入院。将他们与85例匹配的年轻患者（年轻组）进行比较。每组包括66例男性和19例女性患者。每组中，45.9%的患者为枪伤，52.9%为刺伤，1.2%为霰弹枪伤。每组的平均损伤严重程度评分为5.5±5.6（范围1 - 29），两组的区域简明损伤评分同样相等。老年患者的平均住院时间为6.9±9.1天，而年轻患者为4.3±5.7天（p<0.05）。27例老年患者在重症监护病房度过7.3±9.2天，而19例年轻患者停留3.4±3.2天（p<0.05）。58例老年患者共发现91种合并症，而15例年轻患者为18种（p<0.0001）。老年组进行了86项侵入性操作，年轻组为96项（p = 无显著性差异）。19例老年患者（22.3%）和15例年轻患者（17.6%）出现一种或多种并发症，包括死亡（p = 无显著性差异）。91%存活的老年患者出院回家，而存活的年轻患者为100%（p<0.01）。
遭受穿透性创伤的老年患者比年轻患者有更多合并症。这可能是他们住院时间更长且出院回家能力较低的原因。这些患者并发症发生率没有增加，应继续积极治疗。
