gms | German Medical Science

Objectives: We hypothesized that clinical data obtained during initial hospital stay could accurately predict long term survival.

Methods: We used our trauma registry and hospital database to review all trauma admissions (age ≥ 60, Injury Severity Score > 15) to our Level 1 trauma center over the past 7 years. Mechanism of injury, co-morbidities, ICU admission, and ultimate disposition were assessed for 2-7 years post-discharge. Primary outcome was defined as long-term survival.

Results: Results: 342 elderly trauma patients were included in the study. Mean age was 76.2 ± 9.7, and ISS was 21.5 ± 6.9. 119 patients (34.8%) died (mean follow up 18.8 months; range 1.1 -66.2 months). For the 233 survivors, mean follow-up was for 50.2 months (range 24.8 - 83.8 months). Univariate analysis showed post-discharge mortality was associated with age (80.1 ± 9.64 vs. 74.2 ± 9.07), mean number of co-morbidities (1.6 ± 1.1 vs. 1.0 ± 1.2), fall as a mechanism of injury, lower GCS upon arrival (11.85 ± 4.21 vs. 13.73 ± 2.89), intubation at the scene and discharge to an assisted care facility (p < 0.001 for all). Cox regression analysis hazard ratio also showed that independent predictors of mortality at long term follow-up included: older age, fall as a mechanism, lower GCS at admission and discharge to assisted care facility (all = p < 0.0001).

Conclusions: Nearly two-thirds of patients ≥ 60 who were severely injured survived > 4 years following discharge; furthermore, admission data, including younger age, injury mechanism (cause other than falls), higher initial GCS and discharge home predicted a favorable long term outcome. These findings suggest that accessible clinical data at admission can assist prediction of long term survival in the older trauma patient.