Gale Stephen C, Peters JoAnn, Murry Jason S, Crystal Jessica S, Dombrovskiy Viktor Y
Department of Surgery, East Texas Medical Center, Tyler, TX, USA.
Department of Surgery, Rutgers-RWJMS, New Brunswick, NJ, USA.
Ann Med Surg (Lond). 2018 Jan 31;27:22-25. doi: 10.1016/j.amsu.2018.01.005. eCollection 2018 Mar.
Late middle age (LMA), is a watershed between youth and old age, with unique physical and social changes and declines in vitality, but a desire to remain active despite increasing comorbidity. While post-injury outcomes in the elderly are well studied, little is known regarding LMA patients. We analyzed the injured LMA population admitted to a rural, regional Level 1 Trauma Center relative to outcomes for both younger and older patients.
Our registry was queried retrospectively for patients admitted 7/2008- 12/2015; they were divided into three cohorts: 18-54, 55-65, and >65 years. Demographics, injury details, comorbidities, and outcomes were compiled and compared using ANOVA and Chi-square; p < 0.05 was significant.
During the study period, 10,543 were admitted; 1419 (14%) were LMA who experienced overall injury mechanisms, severities and patterns that mirrored the younger cohort. However comorbidity rates were high (56.4%) and comparable to the elderly. LMA patients had the highest rates of alcohol abuse, morbid obesity, and psychiatric illness (p < 0.0001) and suffered the poorest outcomes: highest complications and hospital charges, and longest ICU and hospital LOS. LMA mortality (4.1%) was 41% higher than younger patients (2.9%; p < 0.02) and similar to the older cohort (4.7%; p = 0.32).
The LMA population has similar mechanisms and injury patterns to younger patients, while exhibiting comorbidity rates similar to the elderly. High-energy injuries exact a greater toll in LMA with poorer outcomes and greater resource utilization. Targeted outreach for injury prevention, and future studies, are needed to address high-risk behavior, substance abuse, and societal contributors.
中年后期（LMA）是青年与老年之间的一个分水岭，伴随着独特的身体和社会变化以及活力下降，但尽管合并症增多，人们仍渴望保持活跃。虽然对老年人受伤后的结局已有充分研究，但对于中年后期患者却知之甚少。我们分析了入住一家农村地区一级创伤中心的中年后期受伤人群，并与年轻和老年患者的结局进行了比较。
我们对2008年7月至2015年12月期间入院的患者进行了回顾性查询；将他们分为三个队列：18 - 54岁、55 - 65岁和65岁以上。收集了人口统计学、损伤细节、合并症和结局等信息，并使用方差分析和卡方检验进行比较；p < 0.05具有统计学意义。
在研究期间，共收治10543例患者；其中1419例（14%）为中年后期患者，他们经历的总体损伤机制、严重程度和模式与年轻队列相似。然而，合并症发生率很高（56.4%），与老年人相当。中年后期患者的酒精滥用、病态肥胖和精神疾病发生率最高（p < 0.0001），且结局最差：并发症最多、住院费用最高，重症监护病房（ICU）和住院时间最长。中年后期患者的死亡率（4.1%）比年轻患者（2.9%；p < 0.02）高41%，与老年队列（4.7%；p = 0.32）相似。
中年后期人群的损伤机制和模式与年轻患者相似，而合并症发生率与老年人相似。高能损伤对中年后期患者造成的损害更大，结局更差，资源利用更多。需要有针对性地开展预防损伤宣传以及未来研究，以解决高危行为、药物滥用和社会因素等问题。
