80 岁以上老年人与机动车碰撞：出院后死亡率低于预期。

Octogenarians and motor vehicle collisions: postdischarge mortality is lower than expected.

机构信息

From the Departments of Surgery (K.S., S.D.H., M.L.L., R.J.N., J.M.H.) and Preventive Medicine and Public Health (F.D.); The University of Kansas School of Medicine-Wichita; the Kansas Department of Health and Environment (G.C.); and the Department of Trauma Services, Via Christi Hospital Saint Francis (J.G.W., R.J.N., J.M.H.), Wichita, Kansas.

出版信息

J Trauma Acute Care Surg. 2013 Dec;75(6):1076-80; discussion 1080. doi: 10.1097/TA.0b013e3182aa9cc6.

DOI:10.1097/TA.0b013e3182aa9cc6

PMID:24256684

Abstract

BACKGROUND

Motor vehicle collisions (MVCs) are the second leading cause of injury among octogenarians. Physicians and families lack outcomes-based data to assist in the decision-making process concerning injury treatment in this population. The purpose of this study was to evaluate 1-year postdischarge mortality in octogenarian MVC patients, cause of death, and patterns predictive of mortality.

METHODS

A 10-year retrospective review was conducted of trauma patients 80 years and older who were involved in an MVC and were subsequently discharged alive. Data collected included demographics, injury severity and patterns, hospitalization details, and outcomes. State death database and hospital records were queried to determine cause of death for patients who died within 12 months of hospital discharge. Analyses were conducted to explore if a relationship existed between severity of injury and injury patterns to 12-month postdischarge mortality.

RESULTS

Among the 199 patients included in this study, mean (SD) age and Injury Severity Score (ISS) was 84.2 (3.3) years and 9.3 (8.2), respectively. Twenty-two patients (11.1%) died within 12 months. Among these patients, cause of death was directly related to trauma in nine (40.9%), likely related to trauma in seven (31.8%), and unrelated to trauma in six (27.3%). More severely injured patients (ISS >15, p = 0.0041) and those admitted to the intensive care unit (ICU) (p = 0.0051) were more likely to die within 12 months of discharge. Results indicated a trend toward higher mortality in patients with pneumonia. Rib, hip, and pelvic fractures; spinal injuries; intubation upon hospital arrival; and need for mechanical ventilation were not associated with higher postdischarge mortality rates.

CONCLUSION

The commonly held belief that the majority of octogenarians with MVC-related trauma die within 1 year of hospital discharge is refuted by this study. Only injury severity, ICU admission, and ICU duration were predictive of mortality within 12 months following discharge.

LEVEL OF EVIDENCE

Prognostic study, level III.

摘要

背景

机动车碰撞（MVC）是 80 岁以上人群受伤的第二大主要原因。医生和家属缺乏基于结果的数据来协助这一人群的受伤治疗决策。本研究的目的是评估 80 岁以上 MVC 患者出院后 1 年的死亡率、死亡原因和预测死亡率的模式。

方法

对 10 年来涉及 MVC 并存活出院的 80 岁及以上的创伤患者进行回顾性研究。收集的数据包括人口统计学资料、损伤严重程度和模式、住院详细信息和结局。查询州死亡数据库和医院记录，以确定出院后 12 个月内死亡患者的死因。分析旨在探讨损伤严重程度和损伤模式与出院后 12 个月死亡率之间是否存在关系。

结果

在这项研究中，纳入了 199 名患者，平均（SD）年龄和损伤严重程度评分（ISS）分别为 84.2（3.3）岁和 9.3（8.2）。22 名（11.1%）患者在 12 个月内死亡。在这些患者中，9 例（40.9%）死亡原因与创伤直接相关，7 例（31.8%）可能与创伤有关，6 例（27.3%）与创伤无关。损伤更严重的患者（ISS>15，p=0.0041）和入住重症监护病房（ICU）的患者（p=0.0051）在出院后 12 个月内死亡的可能性更高。结果表明，肺炎患者的死亡率有上升趋势。肋骨、臀部和骨盆骨折、脊柱损伤、入院时插管和需要机械通气与出院后死亡率的升高无关。