New York University School of Medicine, Department of Surgery, NYC Health & Hospitals/Bellevue, New York, USA.
University of Maryland R. Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD, 21201, USA.
Am J Surg. 2020 Nov;220(5):1308-1311. doi: 10.1016/j.amjsurg.2020.06.060. Epub 2020 Jul 2.
While the incidence of geriatric trauma continues to increase, outcomes following severe blunt liver injury (BLI) are unknown. We sought to investigate independent predictors of mortality among elderly trauma patients with severe BLI. A retrospective study of the NTDB (2014-15) identified patients with isolated, high-grade BLI. Patients were stratified into two groups, non-elderly (<65 years) and elderly (≥65 years), and then two management groups: operative within 24 h of admission and non-operative. Demographics and outcomes were compared. Multivariable logistic regression was used to estimate association with mortality. A total of 1133 patients met our inclusion criteria. 107 patients required surgery and 1011 patients were managed non-operatively. Age was independently associated with mortality (AOR 1.04, p < .001). For patients <65 years, need for operative intervention was associated with a 55 times greater likelihood of death (AOR 55.1, p < .001). In patients ≥65 years, operative intervention was associated with a 122 times greater likelihood of death (AOR 122.09, p = .005). Age is independently associated with mortality in patients with high grade BLI.
随着老年创伤的发生率持续增加，严重钝性肝损伤（BLI）后的结局尚不清楚。我们旨在研究严重 BLI 的老年创伤患者死亡的独立预测因素。对 NTDB（2014-15 年）的回顾性研究确定了孤立性高等级 BLI 的患者。患者分为两组，非老年（<65 岁）和老年（≥65 岁），然后分为两组管理：入院后 24 小时内手术和非手术。比较了人口统计学和结局。多变量逻辑回归用于估计与死亡率的关联。共有 1133 名患者符合我们的纳入标准。107 名患者需要手术，1011 名患者接受非手术治疗。年龄与死亡率独立相关（AOR 1.04，p<0.001）。对于<65 岁的患者，需要手术干预与死亡的可能性增加 55 倍相关（AOR 55.1，p<0.001）。对于≥65 岁的患者，手术干预与死亡的可能性增加 122 倍相关（AOR 122.09，p=0.005）。年龄是高等级 BLI 患者死亡的独立相关因素。
