Bauzá Graciela, Lamorte Wayne W, Burke Peter A, Hirsch Erwin F
Department of Surgery, Boston Medical Center, Boston, Massachusetts 02118, USA.
J Trauma. 2008 Feb;64(2):304-10. doi: 10.1097/TA.0b013e3181634893.
Higher mortality in elderly drivers involved in motor vehicle collisions (MVCs) is a major concern in an aging population. We examined a spectrum of age-related differences in injury severity, outcome, and patterns of injuries using our institution's trauma registry and the National Trauma Data Bank.
Injury severity scores (ISSs) and measures of outcome were compared among five age groups (<26, 26-39, 40-54, 55-69, 70+ years) using chi tests and analysis of variance. International Classification of Diseases-9th Revision (ICD-9) codes were used to compute the frequency of specific injuries across groups. We used stratified analysis and multiple logistic regression to control for confounding.
After the age of 25, injury severity, mortality, and length of stay (LOS) all increased progressively with age, whereas likelihood of discharge home decreased for each group (p < 0.001). Restraint use increased with age. However, age-related adverse outcomes were significantly increased even after adjusting for restraint use (p < 0.0001). Unrestrained elderly drivers had the highest mortality and morbidity (p < 0.001), and were least likely to be discharged home (p < 0.001). Abbreviated Injury Scale scores and ICD-9 codes indicated that poor outcomes with older age were driven primarily by head and chest injuries, especially intra-cranial hemorrhage, rib fractures, pneumothorax, and injury to the heart and lungs.
Elderly drivers involved in MVCs have disproportionately poor outcomes primarily because of a greater incidence of head and chest injuries. Seat belt and airbag use in elderly drivers significantly reduce this trend but do not eliminate it. These observations should help establish clinical guidelines for the evaluation of traumatized elderly drivers, develop specific education programs, and safer vehicle design.
在老龄化人口中，机动车碰撞事故（MVC）中老年驾驶员的较高死亡率是一个主要问题。我们使用本机构的创伤登记系统和国家创伤数据库，研究了一系列与年龄相关的损伤严重程度、结局和损伤模式的差异。
使用卡方检验和方差分析，比较了五个年龄组（<26岁、26 - 39岁、40 - 54岁、55 - 69岁、70岁及以上）的损伤严重程度评分（ISS）和结局指标。使用国际疾病分类第九版（ICD - 9）编码计算各组特定损伤的频率。我们使用分层分析和多元逻辑回归来控制混杂因素。
25岁以后，损伤严重程度、死亡率和住院时间均随年龄逐渐增加，而每组出院回家的可能性降低（p < 0.001）。安全带使用随年龄增加。然而，即使在调整安全带使用后，与年龄相关的不良结局仍显著增加（p < 0.0001）。未系安全带的老年驾驶员死亡率和发病率最高（p < 0.001），出院回家的可能性最小（p < 0.001）。简明损伤定级标准评分和ICD - 9编码表明，老年患者的不良结局主要由头部和胸部损伤导致，尤其是颅内出血、肋骨骨折、气胸以及心脏和肺部损伤。
涉及机动车碰撞事故的老年驾驶员结局异常不佳，主要原因是头部和胸部损伤的发生率更高。老年驾驶员使用安全带和安全气囊可显著降低这一趋势，但并不能消除它。这些观察结果应有助于制定评估受创伤老年驾驶员的临床指南、开展特定教育项目以及设计更安全的车辆。
