Legros Vincent, Picard Benjamin, Pasqueron Jean, Kanagaratnam Lukshe, Garrigue Delphine, Rozenberg Emmanuel, Mandrillon Paul, Pottecher Julien, Seube-Remy Pierre-Antoine, Vettese Thomas, Hanouz Jean-Luc, Gosset Pierre, Popoff Benjamin, Willig Mathieu, Cohen Benjamin, Bounes Fanny, Abback Paer Selim
Anesthesiology, Critical Care and Perioperative Medicine, Reims University Hospital, Hopital Maison Blanche, CHU de Reims, 45 Rue Cognacq Jay, 51092, Reims, Cedex, France.
Université de Reims Champagne-Ardenne, EA 3797 VieFra, F-51100, Reims, France.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):3199-3208. doi: 10.1007/s00068-024-02622-8. Epub 2024 Jul 30.
The aging population in France and Western Europe is on the rise, particularly among individuals aged 65 years and older. Although older adults are susceptible to traumatic injuries, they constitute a minority of trauma center admissions especially those aged 85 and above. The aim of our study was to investigate the prognostic factors for mortality among the older old population (aged 85 years and above) managed in ICU of Traumabase group trauma centers.
This retrospective observational cohort study, conducted from 2013 to 2022, analyzed all severely injured older patients (aged ≥ 85 years) managed in 14 ICU trauma centers enrolled in the Traumabase registry. The study examined sociodemographic, clinical, and outcome variables. Frailty was assessed using the Clinical Frailty Scale.
Among the 365 older trauma patients, 190 (52.1%) were classified as non-frail (CFS 1-3), 80 (21.9%) as pre-frail (CFS 4,5), and 95 (26%) as frail (CFS 6-9). Falls were the most common mechanism of injury. High mortality rates were observed, with 43.5% ICU mortality and 45.5% mortality at day 30. Factors most associated with ICU mortality included traumatic brain injury (CGS < 13), pre-hospital micromethod hemoglobin < 13 and severity of injury (ISS > 16).
Factors such as traumatic brain injury and severe hemorrhage (micromethod hemoglobin < 13) and ISS > 16 are associated with ICU mortality in in patients older than 85 years trauma patient. Early geriatric intervention is crucial for optimizing outcomes in this vulnerable population.
法国和西欧的老龄化人口正在增加，尤其是65岁及以上的人群。尽管老年人易受创伤性损伤，但他们在创伤中心的入院患者中占少数，尤其是85岁及以上的患者。我们研究的目的是调查在Traumabase组创伤中心的重症监护病房（ICU）接受治疗的高龄人群（85岁及以上）的死亡预后因素。
这项回顾性观察队列研究于2013年至2022年进行，分析了Traumabase注册登记的14个ICU创伤中心收治的所有重伤老年患者（年龄≥85岁）。该研究检查了社会人口统计学、临床和结局变量。使用临床衰弱量表评估衰弱情况。
在365例老年创伤患者中，190例（52.1%）被分类为非衰弱（临床衰弱量表1-3级），80例（21.9%）为衰弱前期（临床衰弱量表4、5级），95例（26%）为衰弱（临床衰弱量表6-9级）。跌倒为最常见的受伤机制。观察到高死亡率，ICU死亡率为43.5%，30天死亡率为45.5%。与ICU死亡率最相关的因素包括创伤性脑损伤（格拉斯哥昏迷量表<13）、院前微量法血红蛋白<13以及损伤严重程度（损伤严重度评分>16）。
创伤性脑损伤、严重出血（微量法血红蛋白<13）和损伤严重度评分>16等因素与85岁以上创伤患者的ICU死亡率相关。早期老年医学干预对于优化这一脆弱人群的结局至关重要。
