Richmond Therese S, Kauder Donald, Strumpf Neville, Meredith Tammy
School of Nursing, University of Pennsylvania, Philadelphia 19104, USA.
J Am Geriatr Soc. 2002 Feb;50(2):215-22. doi: 10.1046/j.1532-5415.2002.50051.x.
To describe the seriously injured older adult; characterize and compare the differences in injury characteristics and outcomes in three subgroups of seriously injured older adults: aged 65 to 74, 75 to 84, and 85 and older; and identify risk factors for death, complications, and discharge placement at hospital discharge.
A retrospective secondary analysis of a statewide trauma data set from 1988 through 1997.
Data submitted from all designated trauma centers in Pennsylvania.
The data set yielded 38,707 patients with a mean age of 77.5 years with serious injury (mean number of injuries=3.6, mean number of body systems involved=2).
Key outcomes were mortality, complications, and discharge placement. Abbreviated Injury Score categorized injuries and Injury Severity Score (ISS) quantified anatomic severity of injury.
Mortality was 10%. Mean length of stay was 11.5 days. Just over half (52.2%) of survivors were discharged home; 25.4% were discharged to a skilled nursing facility. Injury severity, total number of injuries, complications, and increasing age were predictors of mortality (P <.01). The presence of preexisting comorbid medical conditions increased the odds of experiencing a complication over threefold. Increasing age, total number of injuries, injury to extremities or abdominal contents, injuries due to falls, and lower functional level predicted discharge to a skilled nursing facility (P <.01).
Traumatic injuries affect older adults of all ages and are typically multisystem and life threatening. The standard ISS does not fully capture the potential for mortality in older adults and does not predict discharge placement. The majority of older adults survive multisystem injury. Our findings indicate the need to examine outcomes beyond mortality and to make the identification and management of comorbid conditions a priority. A geriatric consultation service could be an important addition to the interdisciplinary trauma team.
描述严重受伤的老年人；对65至74岁、75至84岁以及85岁及以上这三个严重受伤老年人群体的损伤特征和结局进行特征描述及比较；并确定出院时死亡、并发症及出院安置的风险因素。
对1988年至1997年全州创伤数据集进行回顾性二次分析。
宾夕法尼亚州所有指定创伤中心提交的数据。
该数据集产生了38707例平均年龄为77.5岁的严重受伤患者（平均受伤数量=3.6，平均涉及身体系统数量=2）。
关键结局为死亡率、并发症及出院安置。简略损伤评分对损伤进行分类，损伤严重度评分（ISS）量化损伤的解剖严重程度。
死亡率为10%。平均住院时间为11.5天。略超过一半（52.2%）的幸存者出院回家；25.4%被送往专业护理机构。损伤严重程度、损伤总数、并发症及年龄增长是死亡率的预测因素（P<.01）。存在基础合并症会使发生并发症的几率增加三倍以上。年龄增长、损伤总数、四肢或腹部脏器损伤、跌倒所致损伤及功能水平较低可预测出院后会被送往专业护理机构（P<.01）。
创伤性损伤影响各年龄段的老年人，通常为多系统损伤且危及生命。标准的ISS不能完全反映老年人的死亡风险，也无法预测出院安置情况。大多数老年人能从多系统损伤中存活。我们的研究结果表明，需要研究死亡率以外的结局，并将合并症的识别和管理作为优先事项。老年咨询服务可能是跨学科创伤团队的重要补充。
