General Surgery and Trauma Team, ASST Niguarda, Milano, University of Milan, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA.
World J Emerg Surg. 2020 Mar 10;15(1):18. doi: 10.1186/s13017-020-00297-1.
Motorcyclists are often victims of road traffic incidents. Though elderly patients seem to have worse survival outcomes and sustain more severe injuries than younger patients, concordance in the literature for this does not exist. The aim of the study is to evaluate the impact of age and injury severity on the mortality of patients undergoing motorcycle trauma.
Data of 1725 patients consecutively admitted to our Trauma Center were selected from 2002 to 2016 and retrospectively analyzed. The sample was divided into three age groups: ≤ 17 years, 18-54 years, and ≥ 55 years. Mortality rates were analyzed for the overall population and patients with Injury Severity Score (ISS) ≥ 25. Differences in survival among age groups were evaluated with log-rank test, and multivariate logistic regression models were created to identify independent predictors of mortality.
A lower survival rate was detected in patients older than 55 years (83.6% vs 94.7%, p = 0.049) and in those sustaining critical injuries (ISS ≥ 25, 61% vs 83%, p = 0.021). Age (p = 0.027, OR 1.03), ISS (p < 0.001, OR 1.09), and Revised Trauma Score (RTS) (p < 0.001, OR 0.47) resulted as independent predictors of death. Multivariate analysis identified head (p < 0.001, OR 2.04), chest (p < 0.001, OR 1.54), abdominal (p < 0.001, OR 1.37), and pelvic (p = 0.014, OR 1.26) injuries as independent risk factors related to mortality as well. Compared to the theoretical probability of survival, patients of all age groups showed a survival advantage when managed at a level I trauma center.
We detected anatomical injury distributions and mortality rates among three age groups. Patients aging more than 55 years had an increased risk of death, with a prevalence of severe chest injuries, while younger patients sustained more severe head trauma. Age represented an independent predictor of death. Management of these patients at a level I trauma center may lead to improved outcomes.
摩托车手经常成为道路交通意外的受害者。尽管老年患者的生存结果似乎比年轻患者更差，受伤也更严重，但文献中对此并没有一致的结论。本研究旨在评估年龄和损伤严重程度对摩托车创伤患者死亡率的影响。
从 2002 年至 2016 年，连续选取 1725 名患者的资料，纳入本创伤中心进行回顾性分析。将样本分为三组：≤17 岁、18-54 岁和≥55 岁。分析所有人群和损伤严重度评分（ISS）≥25 的患者的死亡率。使用对数秩检验评估年龄组之间的生存差异，建立多变量逻辑回归模型以确定死亡率的独立预测因素。
年龄大于 55 岁的患者生存率较低（83.6%比 94.7%，p=0.049），严重受伤患者（ISS≥25 分，61%比 83%，p=0.021）生存率也较低。年龄（p=0.027，OR 1.03）、ISS（p<0.001，OR 1.09）和修订创伤评分（RTS）（p<0.001，OR 0.47）是死亡的独立预测因素。多变量分析确定头部（p<0.001，OR 2.04）、胸部（p<0.001，OR 1.54）、腹部（p<0.001，OR 1.37）和骨盆（p=0.014，OR 1.26）损伤也是死亡率的独立危险因素。与理论生存率相比，所有年龄组的患者在一级创伤中心接受治疗时都表现出生存优势。
我们发现了三组之间的解剖损伤分布和死亡率。年龄大于 55 岁的患者死亡风险增加，胸部严重损伤更为常见，而年轻患者头部创伤更为严重。年龄是死亡的独立预测因素。将这些患者在一级创伤中心进行管理可能会改善预后。
