Emergency Medicine Department, National University Hospital, National University Health System, Singapore.
Ann Acad Med Singap. 2017 May;46(5):185-194.
Age-related physiological changes predispose older road users to higher mortality from traffic crashes. We aimed to describe the injury epidemiology of these patients, and explore the association between the comorbidity polypharmacy score (CPS) and outcomes.
This retrospective study utilised data from the Trauma Registry in the National University Hospital, Singapore, between January 2011 and December 2014. Patients involved in traffic crashes aged 45 years and above with injury severity scores (ISS) of 9 and higher were included.
There were 432 patients; median age was 58 (interquartile range, 51 to 65.5) years with predominance of male patients (82.2%) and Chinese ethnicity (66%). Overall mortality was 9.95%, with lower odds associated with higher Glasgow Coma Scale (odds ratio [OR] 0.73; 95% confidence interval [CI], 0.65 to 0.81, <0.001), higher diastolic blood pressure (OR 0.98; 95% CI, 0.97 to 1.00, = 0.031), and lower ISS of 9 to 15 (OR 0.10; 95% CI, 0.02 to 0.43, = 0.002). The need for blood products was associated with higher mortality (OR 7.62; 95% CI, 2.67 to 21.7, <0.001). CPS did not predict mortality. Independent predictors of discharge venue included length of stay, tier of injury and CPS group. Moderate CPS was statistically significant for nursing home placement (OR 10.7; 95% CI, 2.33 to 49.6, = 0.002) but not for rehabilitation facility.
CPS score is useful in predicting discharge to a nursing home facility for older patients with traffic crashes. Further larger studies involving other trauma types in the Asian population are needed to evaluate its utility.
年龄相关的生理变化使老年道路使用者更容易因交通事故而死亡。我们旨在描述这些患者的损伤流行病学，并探讨合并症多药治疗评分（CPS）与结果之间的关系。
本回顾性研究使用了 2011 年 1 月至 2014 年 12 月期间新加坡国立大学医院创伤登记处的数据。纳入了年龄在 45 岁及以上、损伤严重程度评分（ISS）为 9 分及以上且涉及交通事故的患者。
共纳入 432 例患者，中位年龄为 58 岁（四分位距，51 岁至 65.5 岁），患者以男性（82.2%）和华裔（66%）为主。总体死亡率为 9.95%，格拉斯哥昏迷量表评分较高（比值比[OR] 0.73；95%置信区间[CI]，0.65 至 0.81， ＜0.001）、舒张压较高（OR 0.98；95%CI，0.97 至 1.00， = 0.031）和 ISS 为 9 至 15 分（OR 0.10；95%CI，0.02 至 0.43， = 0.002）的患者死亡率较低。需要输血与死亡率较高相关（OR 7.62；95%CI，2.67 至 21.7， ＜0.001）。CPS 评分不能预测死亡率。出院地点的独立预测因素包括住院时间、损伤级别和 CPS 分组。中度 CPS 与疗养院安置呈统计学显著相关（OR 10.7；95%CI，2.33 至 49.6， = 0.002），但与康复机构无关。
CPS 评分可用于预测交通事故老年患者入住疗养院。需要在亚洲人群中进行其他创伤类型的更大规模研究，以评估其效用。
