Yeung Janice H H, Chang Annice Ling Mui, Ho Wendy, So Fung Ling, Graham Colin A, Cheng Beatrice, Cheung N K, Ho H F, Yuen W K, Kam C W, Rainer Timothy H
Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong SAR, People's Republic of China.
Injury. 2008 Sep;39(9):1034-41. doi: 10.1016/j.injury.2008.03.017. Epub 2008 Jul 29.
Trauma is the eighth leading cause of death in Hong Kong. In 2002, 18.5% of the population of Hong Kong was aged 55 years or above, which increased to 22.1% in 2006. The increasing older population in Hong Kong presents a challenge to the health care system yet there is little local data on older trauma patients. The objectives of this study are firstly to describe the epidemiology of high risk trauma in older patients in Hong Kong, and secondly to identify predictors of trauma mortality.
Retrospective analysis of prospectively collected data from a centralised trauma database; data collected from 2002 to 2004 from four trauma centres in Hong Kong.
Between 2002 and 2004, the four trauma centres had a total of 2,124,175 emergency department attendances of which 376,021 (17.7%) were trauma patients, and 80,827 (3.8%) were aged 55 years or older. 810 injured older patients met the inclusion criteria for this study. 380 (46.9%) patients had co-morbidity at the time of injury. Common causes of injury were falls (50.0%, 405/810) and motor vehicle crashes (33.6%, 272/810) of which (77.2%, 210/272) were pedestrians. Mortality was 24.4% (198/810) and increased with advancing age (p<0.0001). 53.5% (433/810) of patients had major trauma (ISS>15). Head injury contributed to 80.3% (159/198) of deaths. 38.4% (311/810) of patients required operations. Most patients were discharged home (40.5%, 328/810) and one-third (270/810) required rehabilitation. Significant predictors of mortality included co-morbidity, injury severity score, age and decreasing Glasgow Coma Score.
Pedestrians struck by motor vehicles and falls are the principal causes of trauma in older patients in Hong Kong. Mortality increased with advancing age. The independent indicators of trauma mortality in older patients are co-morbidity, age, ISS and GCS.
创伤是香港第八大死因。2002年，香港18.5%的人口年龄在55岁及以上，到2006年这一比例增至22.1%。香港老年人口的增加给医疗保健系统带来了挑战，但当地关于老年创伤患者的数据很少。本研究的目的，一是描述香港老年患者高危创伤的流行病学情况，二是确定创伤死亡率的预测因素。
对前瞻性收集的来自一个集中创伤数据库的数据进行回顾性分析；数据收集自2002年至2004年香港的四个创伤中心。
在2002年至2004年期间，四个创伤中心的急诊科就诊总数为2,124,175人次，其中376,021人次（17.7%）为创伤患者，80,827人次（3.8%）年龄在55岁及以上。810名受伤的老年患者符合本研究的纳入标准。380名（46.9%）患者在受伤时有合并症。受伤的常见原因是跌倒（50.0%，405/810）和机动车碰撞（33.6%，272/810），其中（77.2%，210/272）是行人。死亡率为24.4%（198/810），且随年龄增长而增加（p<0.0001）。53.5%（433/810）的患者有严重创伤（损伤严重度评分>15）。头部损伤导致80.3%（159/198）的死亡。38.4%（311/810）的患者需要手术。大多数患者出院回家（40.5%，328/810），三分之一（270/810）的患者需要康复治疗。死亡率的显著预测因素包括合并症、损伤严重度评分、年龄和格拉斯哥昏迷评分降低。
在香港，被机动车撞击的行人及跌倒，是老年患者创伤的主要原因。死亡率随年龄增长而增加。老年患者创伤死亡率的独立指标是合并症、年龄、损伤严重度评分和格拉斯哥昏迷评分。
