Lalwani Sanjeev, Gera Sakshi, Sawhney Chhavi, Mathur Purva, Lalwani Parin, Misra Mahesh Chandra
Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India.
Senior Resident, Department of Anaesthesia, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India.
J Emerg Trauma Shock. 2020 Oct-Dec;13(4):269-273. doi: 10.4103/JETS.JETS_102_18. Epub 2020 Dec 7.
The management of geriatric trauma patients is challenging because of the altered physiology and co-existent medical conditions. To study the in-hospital mortality profile of geriatric trauma victims and the parameters associated with the mortality, we conducted this retrospective analysis.
In a retrospective review of geriatric trauma admissions (above 60 years) over a 3-year period, we studied the association of age, gender, comorbidities, mechanism of injury (MOI), Glasgow coma score (GCS), injury severity score (ISS), systolic blood pressure, and hemoglobin (Hb) level on admission with hospital mortality. Univariate and Multivariable logistic regression was used to estimate odds and find independent associated parameters. < 0.05 was considered as statistically significant.
Out of 881 patients, 208 (23.6%) patients died in hospital. The most common MOI was fall (53.3%) followed by motor vehicle collision (31.1%) and other mechanisms (14.5%). The in-hospital mortality was significantly higher and adjusted odds ratio (OR) for mortality were higher for male gender (2.11 [1.04-4.26]), higher ISS (6.75 [2.07-21.95] for ISS >30), low GCS (<8) (4.6 [2.35-8.97]), low Hb (<9) (1.68 [0.79-3.55]), hypotension on admission (32.42 [10.89-96.52]) as compared to other groups. Adjusted OR was 3.19 (1.55-6.56); 7.67 (1.10-53.49); 1.13 (0.08-17.12) for co-existent cardiovascular, renal, and hepatic comorbidities, respectively.
Male gender, higher ISS, low GCS, low Hb, hypotension on admission, co-existent cardiovascular, renal and hepatic comorbidities are associated with increased mortality in geriatric trauma patients.
由于生理机能改变以及并存多种疾病，老年创伤患者的管理颇具挑战性。为研究老年创伤受害者的院内死亡率情况以及与死亡率相关的参数，我们开展了此次回顾性分析。
在对3年期间老年创伤入院患者（60岁以上）进行回顾性研究时，我们分析了年龄、性别、合并症、损伤机制（MOI）、格拉斯哥昏迷评分（GCS）、损伤严重程度评分（ISS）、入院时收缩压和血红蛋白（Hb）水平与医院死亡率之间的关联。采用单因素和多因素逻辑回归来估计比值比并找出独立相关参数。P < 0.05被视为具有统计学意义。
在881例患者中，208例（23.6%）患者在医院死亡。最常见的损伤机制是跌倒（53.3%），其次是机动车碰撞（31.1%）和其他机制（14.5%）。与其他组相比，男性的院内死亡率显著更高，死亡率的调整比值比（OR）也更高（2.11 [1.04 - 4.26]），ISS较高（ISS > 30时为6.75 [2.07 - 21.95]），GCS较低（< 8）（4.6 [2.35 - 8.97]），Hb较低（< 9）（1.68 [0.79 - 3.55]），入院时低血压（32.42 [10.89 - 96.52]）。并存心血管、肾脏和肝脏合并症的调整OR分别为3.19（1.55 - 6.56）；7.67（1.10 - 53.49）；1.13（0.08 - 17.12）。
男性、较高ISS、低GCS、低Hb、入院时低血压以及并存心血管、肾脏和肝脏合并症与老年创伤患者死亡率增加相关。
