From the Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, Tennessee.
J Trauma Acute Care Surg. 2021 Apr 1;90(4):738-743. doi: 10.1097/TA.0000000000003062.
As the prevalence of geriatric trauma patients has increased, protocols are being developed to address the unique requirements of this demographic. However, categorical definitions for geriatric patients vary, potentially creating confusion concerning which patients should be cared for according to geriatric-specific standards. The aim of this study was to identify data-driven cut points for mortality based on age to support implementation of age-driven guidelines.
Adults aged 18 to 100 years with blunt or penetrating injury were selected from 95 hospitals' trauma registries. Change point analysis techniques were used to detect inflection points in the proportion of deaths at each age. Based on these calculated points, patients were allocated into age groups, and their characteristics and outcomes were compared. Logistic regression was used to estimate risk-adjusted in-hospital mortality controlling for sex, race, Injury Severity Score, Glasgow Coma Scale, and number of comorbidities.
A total of 255,099 patients were identified (female, 45.7%; mean age, 59.3 years; mean Injury Severity Score, 8.69; blunt injury, 92.6%). Statistically significant increases in mortality rate were noted at ages 55, 77, and 82 years. Compared with the referent group (age, <55 years), adjusted odds ratios (AORs) showed increases in mortality if age 55 to 76 years (AOR, 2.42), age 77 to 81 years (AOR, 4.70), or age 82 years or older (AOR, 6.43). National Trauma Data Standard-defined comorbidities significantly increased once age surpassed 55 years, as the rate more than doubled for each of the older age categories (p < 0.001). As age increased, each group was more likely to be female, have dementia, sustain a ground level fall, and be discharged to a skilled nursing facility (p < 0.001).
This large multicenter analysis established a clinically and statistically significant increase in mortality at ages 55, 77, and 82 years. This research strongly suggests that trauma patients older than 55 years be considered for inclusion in geriatric trauma protocols. The other age inflection points identified (77 and 82 years) may also warrant additional specialized care considerations.
Epidemiological study, level III; Care management, level IV.
随着老年创伤患者的患病率增加，目前正在制定针对这一人群特殊需求的方案。然而，老年患者的分类定义各不相同，这可能导致人们对于哪些患者应按照老年特定标准进行治疗存在混淆。本研究旨在通过基于年龄的死亡率数据驱动临界点来确定支持实施基于年龄的指南的依据。
从 95 家医院的创伤登记处中选择年龄在 18 岁至 100 岁之间的钝器或穿透性损伤成人患者。采用变化点分析技术来检测每个年龄组死亡比例的拐点。根据这些计算出的点，将患者分配到年龄组，并比较其特征和结局。使用逻辑回归来估计风险调整后的院内死亡率，同时控制性别、种族、损伤严重程度评分、格拉斯哥昏迷评分和合并症数量。
共确定了 255099 例患者（女性占 45.7%；平均年龄 59.3 岁；平均损伤严重程度评分 8.69；钝器伤占 92.6%）。年龄在 55、77 和 82 岁时，死亡率显著增加。与参考组（年龄＜55 岁）相比，如果年龄在 55 至 76 岁（优势比[OR]，2.42）、77 至 81 岁（OR，4.70）或 82 岁或以上（OR，6.43），则调整后的优势比（AOR）显示死亡率增加。国家创伤数据标准定义的合并症随着年龄超过 55 岁而显著增加，每个年龄组的发病率都增加了一倍以上（p＜0.001）。随着年龄的增长，每个年龄组更有可能是女性、患有痴呆症、发生地面水平跌倒，以及被送往专业护理机构（p＜0.001）。
这项大型多中心分析确定了 55、77 和 82 岁时死亡率显著增加的临床和统计学意义。这一研究强烈表明，年龄超过 55 岁的创伤患者应考虑纳入老年创伤方案。确定的其他年龄拐点（77 和 82 岁）也可能需要进一步的专门护理考虑。
流行病学研究，III 级；护理管理，IV 级。
