Division of Urology, Department of Surgery, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL 60612, USA.
J Am Coll Surg. 2011 Sep;213(3):415-21. doi: 10.1016/j.jamcollsurg.2011.06.001. Epub 2011 Jul 1.
Geriatric trauma patients (GTPs) are the fastest growing segment of patients admitted to trauma centers. We examined the characteristics and outcomes of genitourinary (GU) trauma sustained by GTPs compared with nongeriatric trauma patients (NGTPs).
The National Trauma Data Bank v8.0 was searched by ICD-9 CM codes for GU injuries in GTPs 65 years or older compared with NGTPs aged 18 to 64 years. The incidence of GU trauma, mechanism of injury, Injury Severity Score (ISS), surgical intervention, pre-existing comorbidities, hospital complications, discharge disposition, and mortality were analyzed. Chi-square test was used to compare the distribution for categorical variables and t-test was used to compare means of continuous variables between GTPs and NGTPs.
Of the 9,470 patients with GU trauma, 852 patients (9.0%) were 65 years old or older, and 8,618 patients (91.0%) were 18 to 64 years. GTPs were more likely to sustain injury to the bladder or urethra (28.9% vs 20.5% p < 0.001), and less likely to the penis (0.5% vs 3.4% p < 0.001) and scrotum or testes (1.5% vs 7.7% p < 0.001). Rates of injury to the kidney (67.5% vs 65.9%) were similar. GTPs more commonly sustained blunt trauma (92.8% vs 74.4% p < 0.0001). Although the mean Injury Severity Scores for GTPs and NGTPs were similar (17.7 vs 18.1), GTPs were more commonly admitted to the ICU (41.8% vs 31.6% p < 0.001) and had a longer ICU stay (6.6 vs 5.7 days p = 0.02). Renal embolization, nephrectomy, and nonoperative management of renal injuries were similar in both cohorts. GTPs had significantly more comorbidities and hospital complications. The mortality rate was significantly higher for GTPs (18.5% vs 9.9%, p < 0.0001).
GTPs sustain a significant number of GU injuries. Penetrating GU injuries are less common in GTPs. Although GTPs and NGTPs had similar mean Injury Severity Scores, GTPs had more ICU admissions, longer ICU stays, and twice the mortality rate when compared with NGTPs.
老年创伤患者（GTPs）是创伤中心收治患者中增长最快的群体。我们研究了与非老年创伤患者（NGTPs）相比，GTPs 发生的泌尿生殖（GU）创伤的特征和结果。
通过 ICD-9 CM 代码在国家创伤数据库 v8.0 中搜索 65 岁或以上的 GTP 中 GU 损伤，与 18 至 64 岁的 NGTP 进行比较。分析 GU 创伤的发生率、损伤机制、损伤严重程度评分（ISS）、手术干预、预先存在的合并症、医院并发症、出院去向和死亡率。卡方检验用于比较分类变量的分布，t 检验用于比较 GTPs 和 NGTPs 之间连续变量的平均值。
在 9470 例 GU 创伤患者中，852 例（9.0%）年龄在 65 岁或以上，8618 例（91.0%）年龄在 18 至 64 岁。GTPs 更有可能发生膀胱或尿道损伤（28.9%比 20.5%，p<0.001），而阴茎损伤（0.5%比 3.4%，p<0.001）和阴囊或睾丸损伤（1.5%比 7.7%，p<0.001）的可能性较小。肾脏损伤的发生率（67.5%比 65.9%）相似。GTPs 更常见钝性创伤（92.8%比 74.4%，p<0.0001）。尽管 GTPs 和 NGTPs 的平均损伤严重程度评分相似（17.7 比 18.1），但 GTPs 更常见于 ICU 入住（41.8%比 31.6%，p<0.001），ICU 入住时间更长（6.6 比 5.7 天，p=0.02）。两组患者的肾栓塞、肾切除术和肾损伤的非手术治疗相似。GTPs 合并症和医院并发症明显更多。GTPs 的死亡率明显更高（18.5%比 9.9%，p<0.0001）。
GTPs 发生了大量的 GU 损伤。穿透性 GU 损伤在 GTPs 中较少见。尽管 GTPs 和 NGTPs 的平均损伤严重程度评分相似，但与 NGTPs 相比，GTPs 有更多的 ICU 入院、更长的 ICU 住院时间和两倍的死亡率。
