Major Trauma in Elderly and Younger Patients. Factor's Affecting Outcome

Abstract

Purpose : To analyze the mechanism of injury, hospital course, functional outcome,

and factors influencing outcome for elderly patients and younger patients sustaining

major trauma.

Methods : From June 1994 to May 1997, we have reviewed retrospectively the 56

patients over 65 years old with Injury Severity Score(ISS)≥10 visiting our emergency center by trauma and compared to a random group of same number of younger(aged

15-64) patients. The mechanism of injury, body region affected, ISS, shock, Glasgow

Coma Scale(GCS), A Severity Characterization Of Trauma(ASCOT), change from level

of prehospital function, and mortality. Hospital data was obtained from medical records and follow-up(mean, 21 months) data by telephone for all patients. The chi-square was used to analyze discrete differences between study groups. Numerical data were compared with two-tailed Student's t tests, with results presented as the mean standard deviation. P<0.05 was taken as the measure of statistical significance.

Results : Motor vehicle accidents were the leading mechanism of injury and main

cause of death in both groups. Closed head injury and extremity fracture were the most

frequent type of injuries in elderly patients. Although younger group had more severe ISS, the older group had higher fatality and complication rate. Factors affecting mortality in elderly patients were shock at admission(p=0.001), low GCS(p<0.001), low Revised Trauma Score(RTS)(p=0.001), low ASCOT(p=0.001) and low ISS(p=0.038). On admission 94.6% of patients were independent, but at discharge only 32.1% of patients were independent functional status(73.2% in younger group). Factors affecting change of functional outcome in elderly patients were GCS(p=0.006), RTS(p=0.04), complication(p=0.006), injury on extremity(p=0.023), many region of injury(p=0.03), and

traffic accident(p=0.035). ASCOT score is higher than real survivor rate in both group.

This means our outcome is bad.

Conclusion The elderly group had higher mortality rates and complication rates iud

higher property to make the functional level worse. Predicted outcome by ASCOT

exceeded the real survival rate. We recognized that our management of trauma patients should be analysed for better outcome.