Popp Daniel, Frankewycz Borys, Lang Siegmund, Ernstberger Antonio, Alt Volker, Worlicek Michael, Kerschbaum Maximilian
Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany.
Clinic for Trauma and Orthopedic Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
J Clin Med. 2021 Jan 7;10(2):185. doi: 10.3390/jcm10020185.
Severely injured elderly patients pose a significant burden to trauma centers and, compared with younger patients, have worse prognoses and higher mortality rates after major trauma. The objective of this study was to identify the etiological mechanisms that are associated with severe trauma in elderly patients and to detect which injuries correlate with high mortality in elderly patients.
Using a prospect cohort study model over an 11-year period, severely injured patients (ISS ≥ 16) were divided into two age groups (Group 1: 18-64; Group 2: 65-99 years). A comparison of the groups was conducted regarding injury frequency, trauma mechanism, distribution of affected body parts (AIS and ISS regions) and injury related mortality.
In total, 1008 patient were included (Group 1: = 771; Group 2: = 237). The most relevant injury in elderly patients was falling from low heights (<3 m) in contrast to traffic accident in young patients. Severely injured patients in the older age group showed a significantly higher overall mortality rate compared to the younger group (37.6% vs. 11.7%; = 0.000). In both groups, the 30-day survival for patients without head injuries was significantly better compared to patients with head injuries (92.7% vs. 85.3%; = 0.017), especially analyzing elderly patients (86.6% vs. 58.6%; = 0.003). The relative risk of 30-day mortality in patients who suffered a head injury was also higher in the elderly group (OR: Group 1: 4.905; Group 2: 7.132).
In contrast to younger patients, falls from low heights (<3 m) are significant risk factors for severe injuries in the geriatric collective. Additionally, elderly patients with an ISS ≥ 16 had a significantly higher mortality rate compared to severe injured younger patients. Head injuries, even minor head traumata, are associated with a significant increase in mortality. These findings will contribute to the development of more age-related therapy strategies in severely injured patients.
重伤老年患者给创伤中心带来了巨大负担，与年轻患者相比，遭受重大创伤后的预后更差，死亡率更高。本研究的目的是确定与老年患者严重创伤相关的病因机制，并检测哪些损伤与老年患者的高死亡率相关。
采用前瞻性队列研究模型，对11年间的重伤患者（损伤严重度评分[ISS]≥16）分为两个年龄组（第1组：18 - 64岁；第2组：65 - 99岁）。对两组在损伤频率、创伤机制、受影响身体部位的分布（简明损伤定级[AIS]和ISS区域）以及损伤相关死亡率方面进行比较。
总共纳入1008例患者（第1组：n = 771；第2组：n = 237）。与年轻患者的交通事故相比，老年患者最相关的损伤是从低高度（<3米）跌落。老年组重伤患者的总体死亡率明显高于年轻组（37.6%对11.7%；P = 0.000）。在两组中，无头部损伤患者的30天生存率明显优于有头部损伤的患者（92.7%对85.3%；P = 0.017），特别是分析老年患者时（86.6%对58.6%；P = 0.003）。老年组头部受伤患者30天死亡率的相对风险也更高（比值比[OR]：第1组：4.905；第2组：7.132）。
与年轻患者不同，从低高度（<3米）跌落是老年人群严重损伤的重要危险因素。此外，ISS≥16的老年患者与重伤年轻患者相比，死亡率明显更高。头部损伤，即使是轻度头部创伤，也与死亡率显著增加相关。这些发现将有助于制定针对重伤患者更具年龄相关性的治疗策略。
