Gitajn Ida L, Castillo Renan, Breazeale Stephen, Schoonover Carrie, Berger Peter, Huang Yanjie, OʼHara Nathan, OʼToole Robert V, Sciadini Marcus F
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD.
J Orthop Trauma. 2017 Aug;31(8):e230-e235. doi: 10.1097/BOT.0000000000000864.
To evaluate in-hospital, 1-year, and 5-year survivorship of geriatric patients after high-energy trauma, to compare survivorship of geriatric patients who sustained high-energy trauma with that of those who sustained low-energy trauma, and to identify predictors for mortality.
Retrospective.
Urban Level I trauma center.
Study group of 1849 patients with high-energy trauma and comparison group of 761 patients with low-energy trauma.
Each patient was observed from the time of index admission through the end of the study period or until death or readmission.
Long-term survivorship based on the Social Security Death Index.
Survivorship between patients with high-energy and low-energy injuries was statistically significant. Among patients who sustained high-energy injuries, in-hospital mortality was 8%, 1-year mortality was 15%, and 5-year mortality was 25%. Among patients who sustained low-energy injuries, in-hospital mortality was 3%, 1-year mortality was 23%, and 5-year mortality was 40%. Low-energy mechanism of injury was an independent predictor for 1-year and 5-year mortality, even when controlling for Charlson Comorbidity Index (CCI), Injury Severity Score (ISS), age, sex, body mass index (BMI), and admission Glasgow Coma Scale (GCS) score.
Geriatric patients with high-energy injuries and those with low-energy injuries seem to represent different patient populations, and low-energy mechanism seems to be a marker for frailty. High-energy mechanism was associated with lower long-term mortality rates, even when controlling for CCI, ISS, age, sex, BMI and admission GCS score.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估老年患者在遭受高能创伤后的院内、1年和5年生存率，比较遭受高能创伤的老年患者与遭受低能创伤的老年患者的生存率，并确定死亡的预测因素。
回顾性研究。
城市一级创伤中心。
1849例高能创伤患者的研究组和761例低能创伤患者的对照组。
从首次入院时起观察每位患者至研究期结束，或直至死亡或再次入院。
基于社会保障死亡指数的长期生存率。
高能损伤和低能损伤患者之间的生存率有统计学意义。在遭受高能损伤的患者中，院内死亡率为8%，1年死亡率为15%，5年死亡率为25%。在遭受低能损伤的患者中，院内死亡率为3%，1年死亡率为23%，5年死亡率为40%。即使在控制了Charlson合并症指数（CCI）、损伤严重程度评分（ISS）、年龄、性别、体重指数（BMI）和入院时格拉斯哥昏迷量表（GCS）评分后，低能损伤机制仍是1年和5年死亡率的独立预测因素。
高能损伤的老年患者和低能损伤的老年患者似乎代表不同的患者群体，低能损伤机制似乎是虚弱的一个标志。即使在控制了CCI、ISS、年龄、性别、BMI和入院GCS评分后，高能损伤机制与较低的长期死亡率相关。
预后III级。有关证据水平的完整描述，请参阅作者须知。
