Taylor Michelle D, Tracy J Kathleen, Meyer Walter, Pasquale Michael, Napolitano Lena M
Department of Surgery, University of Maryland School of Medicine, Baltimore, USA.
J Trauma. 2002 Sep;53(3):407-14. doi: 10.1097/00005373-200209000-00001.
As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe consequences from traumatic injuries compared with the young, presumably resulting in increased resource use. In this study, we sought to examine ICU resource use in trauma on the basis of age and injury severity.
This study was a retrospective review of trauma registry data prospectively collected on 26,237 blunt trauma patients admitted to all trauma centers (n = 26) in one state over 24 months (January 1996-December 1997). Age-dependent and injury severity-dependent differences in mortality, ICU length of stay (LOS), and hospital LOS were evaluated by logistic regression analysis.
Elderly (age > or = 65 years, n = 7,117) patients had significantly higher mortality rates than younger (age < 65 years) trauma patients after stratification by Injury Severity Score (ISS), Revised Trauma Score, and other preexisting comorbidities. Age > 65 years was associated with a two- to threefold increased mortality risk in mild (ISS < 15, 3.2% vs. 0.4%; < 0.001), moderate (ISS 15-29, 19.7% vs. 5.4%; < 0.001), and severe traumatic injury (ISS > or = 30, 47.8% vs. 21.7%; < 0.001) compared with patients aged < 65 years. Logistic regression analysis confirmed that elderly patients had a nearly twofold increased mortality risk (odds ratio, 1.87; confidence interval, 1.60-2.18; < 0.001). Elderly patients also had significantly longer hospital LOS after stratifying for severity of injury by ISS (1.9 fewer days in the age 18-45 group, 0.89 fewer days in the age 46-64 group compared with the age > or = 65 group). Mortality rates were higher for men than for women only in the ISS < 15 (4.4% vs. 2.6%, < 0.001) and ISS 15 to 29 (21.7% vs. 17.6%, = 0.031) groups. ICU LOS was significantly decreased in elderly patients with ISS > or = 30.
Age is confirmed as an independent predictor of outcome (mortality) in trauma after stratification for injury severity in this largest study of elderly trauma patients to date. Elderly patients with severe injury (ISS > 30) have decreased ICU resource use secondary to associated increased mortality rates.
随着人口老龄化，老年人在创伤患者中所占比例将日益突出。与年轻人相比，老年人因创伤性损伤所遭受的后果更为严重，这可能导致资源使用增加。在本研究中，我们试图根据年龄和损伤严重程度来研究创伤患者在重症监护病房（ICU）的资源使用情况。
本研究是一项回顾性研究，对一个州内所有26家创伤中心在24个月（1996年1月至1997年12月）期间前瞻性收集的26237例钝性创伤患者的登记数据进行分析。通过逻辑回归分析评估死亡率、ICU住院时间（LOS）和医院住院时间在年龄和损伤严重程度方面的差异。
根据损伤严重程度评分（ISS）、修订创伤评分和其他并存的合并症进行分层后，老年（年龄≥65岁，n = 7117）患者的死亡率显著高于年轻（年龄<65岁）创伤患者。与年龄<65岁的患者相比，年龄>65岁在轻度（ISS<15，3.2%对0.4%；<0.001）、中度（ISS 15 - 29，19.7%对5.4%；<0.001）和重度创伤性损伤（ISS≥30，47.8%对21.7%；<0.001）中死亡风险增加两到三倍。逻辑回归分析证实老年患者死亡风险增加近两倍（优势比，1.87；置信区间，1.60 - 2.18；<0.001）。根据ISS对损伤严重程度进行分层后，老年患者的医院住院时间也显著更长（18 - 45岁组比年龄≥65岁组少1.9天，46 - 64岁组比年龄≥65岁组少0.89天）。仅在ISS<15（4.4%对2.6%，<0.001）和ISS 15至29（21.7%对17.6%，= 0.031）组中男性死亡率高于女性。ISS≥30的老年患者ICU住院时间显著缩短。
在这项迄今为止关于老年创伤患者的最大规模研究中，年龄被确认为在根据损伤严重程度分层后创伤结局（死亡率）的独立预测因素。严重损伤（ISS>30）的老年患者由于相关死亡率增加导致ICU资源使用减少。
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