Schoeneberg Carsten, Probst Thomas, Schilling Marc, Wegner Alexander, Hussmann Bjoern, Lendemans Sven
Scand J Trauma Resusc Emerg Med. 2014 Aug 8;22:45. doi: 10.1186/s13049-014-0045-3.
Demographic change is expected to result in an increase in cases of severely injured elderly patients. To determine special considerations in treatment and outcome, patients aged 75 years and older were studied.
All patients in the included age group with an Injury Severity Score (ISS) ≥ 16 upon primary admission to hospital between July 2002 and December 2011 were included in this mortality analysis. The data used for this study was gained partly from data submitted to the German Trauma Register and partly from patients' hospital records. A comparison between survivors and decedents was performed, as well as age-adjusted and ISS-adjusted analyses. The odds ratio and relative risk were used to determine predictors for mortality.
One-hundred eight patients met the inclusion criteria. The overall mortality proportion was 57.4%. The decedents were more severely injured (ISS 26 vs. 20, p < 0.001) and suffered more severe head traumas (GCS 4 vs. 12, p < 0.001; AIS head 5 vs. 4, p = 0.006). No differences were found in vital parameters measured at the accident scene or trauma room. Decedents had deranged coagulation with a prolonged PTT (41.1 sec vs. 27.6 sec, p = 0.008) and reduced prothrombin ratio (66.5% vs. 82.8%, p = 0.016).
The treatment of severely injured elderly patients is challenging. The most common cause of accident is falling from less than 3 m with head injuries being determinant. We identified deranged coagulopathy as an important predictor for mortality, suggesting rapid normalization of coagulation might be a key to reducing mortality.
人口结构变化预计将导致重伤老年患者病例增加。为了确定治疗和预后的特殊注意事项，对75岁及以上的患者进行了研究。
本死亡率分析纳入了2002年7月至2011年12月期间首次入院时损伤严重程度评分（ISS）≥16的所有该年龄组患者。本研究使用的数据部分来自提交给德国创伤登记处的数据，部分来自患者的医院记录。对幸存者和死者进行了比较，并进行了年龄调整和ISS调整分析。采用优势比和相对风险来确定死亡率的预测因素。
108例患者符合纳入标准。总死亡率为57.4%。死者受伤更严重（ISS 26 vs. 20，p<0.001），头部创伤更严重（格拉斯哥昏迷量表评分4 vs. 12，p<0.001；简明损伤定级（AIS）头部评分5 vs. 4，p = 0.006）。在事故现场或创伤室测得的生命体征参数没有差异。死者凝血功能紊乱，活化部分凝血活酶时间延长（41.1秒vs. 27.6秒，p = 0.008），凝血酶原比值降低（66.5% vs. 82.8%，p = 0.016）。
重伤老年患者的治疗具有挑战性。最常见的事故原因是从不到3米的高度坠落，头部受伤是决定性因素。我们确定凝血功能紊乱是死亡率的重要预测因素，这表明凝血功能的快速恢复正常可能是降低死亡率的关键。
