Sharma Om P, Oswanski Michael F, Sharma Vijay, Stringfellow Kathryn, Raj Shekhar S
The Toledo Hospital and Toledo Children's Hospital, Toledo, Ohio, USA.
Am Surg. 2007 Apr;73(4):354-8.
To review the trends of trauma in the elderly experienced at our trauma center compared with other Level I trauma centers. This was a retrospective trauma registry analysis (1996-2003) of 2783 blunt trauma in elderly (BTE) and 4568 adult (BTA) patients in a Level 1 trauma center. Falls and motor vehicular crashes were the most common mechanisms noted in 47 per cent and 31 per cent (84% and 13% in BTE, 25% and 42% in BTA). BTE were sicker, with higher Injury Severity Scores (ISS), lengths of stay, and mortality (5% vs 2%, P value < 0.05). ISS was 5.2-fold higher in nonsurvivors to survivors in BTA and 2.4-fold in BTE. Elevation in ISS resulted in higher linear increase in mortality in BTE (vs BTA) at any ISS level. Mortality in patients with ISS > or = 25 was 43.5 per cent vs 23.8 per cent. ISS > or = 50 had 31 per cent adult survivors but no elderly survivors. Among isolated injuries, head trauma in the elderly carried the highest mortality, at 12 per cent (19% in patients with an Abbreviated Injury Score > or = 3). Abdominal injuries were the most lethal (18.3% and 41.2% in patients with an Abbreviated Injury Score > or = 3) in multiple trauma victims (41% vs 18% in isolated trauma). There was 4.4-fold increased mortality in the presence of thoracic trauma. Combined head, chest, and abdominal trauma carried the worst prognosis. Thirty-four per cent of BTE and 88 per cent of BTA patients were discharged home. Elderly patients need more aggressive therapy, as they are sicker with higher mortality.
为了对比我们创伤中心与其他一级创伤中心收治的老年创伤患者的情况，回顾其发展趋势。这是一项对某一级创伤中心1996 - 2003年收治的2783例老年钝性创伤（BTE）患者和4568例成年钝性创伤（BTA）患者进行的回顾性创伤登记分析。跌倒和机动车碰撞是最常见的致伤机制，分别占47%和31%（BTE中为84%和13%，BTA中为25%和42%）。BTE患者病情更重，损伤严重度评分（ISS）更高，住院时间更长，死亡率更高（5%对2%，P值<0.05）。BTA中非幸存者与幸存者的ISS高出5.2倍，BTE中高出2.4倍。在任何ISS水平上，BTE（与BTA相比）中ISS升高导致死亡率呈更高的线性增加。ISS≥25的患者死亡率为43.5%，而BTA为23.8%。ISS≥50的患者中成年患者有31%存活，但老年患者无存活者。在单一损伤中，老年患者头部创伤死亡率最高，为12%（简明损伤评分≥3的患者中为19%）。在多发伤患者中，腹部损伤最为致命（简明损伤评分≥3的患者中为18.3%和41.2%）（单一创伤中分别为41%和18%）。存在胸部创伤时死亡率增加4.4倍。头部、胸部和腹部联合创伤预后最差。34%的BTE患者和88%的BTA患者出院回家。老年患者病情更重、死亡率更高，因此需要更积极的治疗。
