Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan.
Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan.
Ann Emerg Med. 2019 Mar;73(3):281-290. doi: 10.1016/j.annemergmed.2018.09.034. Epub 2018 Nov 15.
Although geriatric trauma patients are becoming more common, few large-scale analyses have comprehensively evaluated geriatric-specific characteristics in trauma. This study aims to clarify the age-specific characteristics, outcomes, and predictive accuracy of current trauma scoring systems among geriatric trauma patients.
Patients with severe trauma, with an Abbreviated Injury Scale score greater than or equal to 3, and registered in the Japan Trauma Data Bank during 2004 to 2015 were retrospectively reviewed. Age-related differences were assessed for injury mechanism, injured region, anatomic and physiologic severity, and inhospital mortality. The mortality risk was evaluated with multivariate mixed-effect models adjusted for Injury Severity Score, Revised Trauma Score, year of injury, and treating facility. Age-related differences in the accuracy of the Injury Severity Score and Revised Trauma Score for predicting inhospital mortality were evaluated with an area under the receiver operating characteristic curve.
We identified 127,303 patients, including 67,316 geriatric patients (52.9%) who were aged 60 years or older. The percentage of geriatric patients increased from 31.9% to 59.7% during the study period. The most frequent injury mechanism was ground-level falls (55.2%) and the most frequently injured region was the pelvis and lower extremities (43.7%). Severity-adjusted mixed-effects models revealed a marked age-dependent increase in mortality. Although the Injury Severity Score had similar predictive accuracy among all generations, the accuracy of the Revised Trauma Score decreased with increasing age.
The characteristics of trauma patients varied widely according to age, and mortality risk increased steadily with increasing age, despite a decrease in anatomic injury severity. The Revised Trauma Score had decreasing predictive accuracy at older ages, suggesting that an alternative measure is needed.
尽管老年创伤患者越来越常见，但很少有大规模的分析全面评估创伤中的老年特定特征。本研究旨在阐明老年创伤患者中当前创伤评分系统的年龄特异性特征、结局和预测准确性。
回顾性分析了 2004 年至 2015 年期间在日本创伤数据库中登记的严重创伤患者，其损伤严重程度评分（Abbreviated Injury Scale 评分）≥3。评估了损伤机制、损伤部位、解剖和生理严重程度以及院内死亡率的年龄相关性差异。使用多变量混合效应模型，调整损伤严重程度评分、修订创伤评分、受伤年份和治疗机构，评估死亡率风险。使用受试者工作特征曲线下面积评估损伤严重程度评分和修订创伤评分预测院内死亡率的准确性的年龄相关性差异。
我们共确定了 127303 例患者，其中 67316 例（52.9%）为 60 岁或以上的老年患者。老年患者的比例从研究期间的 31.9%增加到 59.7%。最常见的损伤机制是地面坠落（55.2%），最常受伤的部位是骨盆和下肢（43.7%）。调整严重程度的混合效应模型显示，死亡率随年龄显著增加。尽管所有年龄段的损伤严重程度评分的预测准确性相似，但修订创伤评分的准确性随年龄增加而降低。
根据年龄，创伤患者的特征差异很大，尽管解剖损伤严重程度下降，但死亡率风险随着年龄的增长而稳步增加。修订创伤评分在年龄较大时预测准确性降低，表明需要替代措施。
