Yamamoto Ryo, Eastridge Brian J, Cestero Ramon F, Yajima Keitaro, Endo Akira, Yamakawa Kazuma, Sasaki Junichi
Trauma Service/Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
World J Emerg Surg. 2025 Apr 4;20(1):28. doi: 10.1186/s13017-025-00595-6.
Advances in healthcare and the development of various technologies have improved disease-free longevity. Although the number of healthy centenarians is gradually increasing, studies on postinjury functions among centenarians are lacking. Therefore, we aimed to determine the clinical predictors of mortality and unfavorable functions after injury among centenarians.
A retrospective study was conducted using a nationwide trauma database, and data from patients aged ≥ 100 years across ≥ 250 institutions during 2019-2022 were analyzed. Patient demographics, comorbidities, mechanism of injury, injury severity, vital signs on arrival, and pre- and in-hospital treatments were compared between survivors and non-survivors as well as between survivors who had and did not have the ability to live independently at discharge, which was defined as Glasgow Outcome Scale (GCS) score of ≤ 3. Independent predictors of in-hospital mortality and unfavorable functions after injury were examined using a generalized estimating equation model to account for institutional and regional differences in the management and characteristics of centenarians.
Of the 409 centenarians, 384 (93.9%) survived to discharge. Although 208 (50.9%) patients had lived independently before the injury, only 91 (22.2%) could live independently at discharge. All patients had blunt injury, and fall from standing was the most frequent (86.6%) mechanism. The injury severity score was 10 ± 5, and surgery/angiography was performed in < 2% of the centenarians, except for fracture fixation in the extremity/pelvis, which was conducted in 225 (55.0%) patients. The adjusted model revealed three independent predictors of in-hospital mortality: male gender, mechanism of injury other than fall from standing, and GCS score on arrival. In contrast, only injury severity in the extremity/pelvis was an independent predictor of unfavorable functions after injury.
Male gender, mechanisms of injury other than fall from standing, and GCS on arrival were associated with higher in-hospital mortality. Injury severity in the extremity/pelvis was related to dependent living after injury among centenarians.
医疗保健的进步和各种技术的发展延长了无病生存期。尽管健康的百岁老人数量在逐渐增加，但关于百岁老人受伤后功能的研究却很缺乏。因此，我们旨在确定百岁老人受伤后死亡和不良功能的临床预测因素。
使用全国性创伤数据库进行回顾性研究，分析了2019年至2022年期间来自≥250家机构的年龄≥100岁患者的数据。比较了幸存者和非幸存者之间以及出院时能够独立生活和不能独立生活的幸存者之间的患者人口统计学特征、合并症、损伤机制、损伤严重程度、入院时生命体征以及院前和院内治疗情况。独立生活能力定义为格拉斯哥预后量表（GCS）评分≤3分。使用广义估计方程模型检查院内死亡和受伤后不良功能的独立预测因素，以考虑百岁老人管理和特征方面的机构和地区差异。
在409名百岁老人中，384名（93.9%）存活至出院。尽管208名（50.9%）患者在受伤前能够独立生活，但出院时只有91名（22.2%）能够独立生活。所有患者均为钝性伤，站立时摔倒为最常见的（86.6%）损伤机制。损伤严重程度评分为10±5分，除225名（55.0%）患者进行了四肢/骨盆骨折固定外，<2%的百岁老人接受了手术/血管造影。调整后的模型显示了院内死亡的三个独立预测因素：男性、非站立时摔倒的损伤机制和入院时的GCS评分。相比之下，只有四肢/骨盆的损伤严重程度是受伤后不良功能的独立预测因素。
男性、非站立时摔倒的损伤机制和入院时的GCS评分与较高的院内死亡率相关。四肢/骨盆的损伤严重程度与百岁老人受伤后依赖他人生活有关。
