Article
Influence of the region of injury at different ages in severely injured patients on risk of death. An analysis of 98,482 patients from the TraumaRegister DGU®
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Authors
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Jonin Serafin Zumsteg
- Universitätsspital Zürich, Klinik für Traumatologie, Zürich, Switzerland
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Yannik Kalbas
- Universitätsspital Zürich, Klinik für Traumatologie, Zürich, Switzerland
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Lara Zankena
- Universitätsspital Zürich, Klinik für Traumatologie, Zürich, Switzerland
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Franziska Ziegenhain
- Universitätsspital Zürich, Klinik für Traumatologie, Zürich, Switzerland
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Julian Scherer
- Universitätsspital Zürich, Klinik für Traumatologie, Zürich, Switzerland
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Nicolas Eibinger
- Universitätsklinik für Orthopädie und Traumatologie, Graz, Austria
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Rolf Lefering
- Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin (IFOM), Bergisch Gladbach, Germany
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Hans-Christoph Pape
- Klinikdirektor, Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Switzerland
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Kai Oliver Jensen
- Universitätsspital Zürich, Klinik für Traumatologie, Zürich, Switzerland
| Published: | June 17, 2024 |
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Outline
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Objectives: The demographic aging process and the increasing activity of older adults lead to a growing number of seriously injured elderly patients. The aim of this retrospective cohort study is to investigate the influence of the leading regions of injury in severely injured patients on the risk of death in different age groups, with a particular focus on older patients.
Methods: Data from the TraumaRegister DGU® from 2015–2020 were analyzed, including severely injured patients admitted to Swiss, German and Austrian trauma centers. Inclusion criteria were a minimum age of 18 years and an Abbreviated Injury Scale (AIS) score of 3 or higher in at least one of nine body regions. Descriptive analysis and odds ratios (OR) for mortality were calculated, stratified by age and leading region of injury.
Result: Of 213,216 patients, 98,482 met the inclusion criteria. Mortality increased from 6.9% in the control group (18–54 years) to 35.9% in the 90+ age group. Leading head injuries had a mortality rate of 22%.
The odds ratio for the risk of death increased with age and reached a maximum value of 13.741 in the 90+ age group.
However, the increase in risk of death for leading head injury with increasing age was significantly lower than in the other regions, with an OR of 9.798. In contrast, the group with a leading thoracic injury increased to an OR of 19.999, abdomen to an OR of 72.251 and extremities to an OR of 25.515.
Conclusion: The study confirms a significant increase in mortality with age in severely injured patients. Contrary to expectations, the risk of death from traumatic head injury is less pronounced in older people compared to other injury regions. Possible causes for the difference can be seen in various circumstances. Due to brain atrophy, older patients have more space to withstand space-occupying intracranial hemorrhage. Another explanation can be found in the classification, which is based on radiological signs and makes no distinction between the trauma mechanisms.
The study suggests that the injury severity grading system needs to be reevaluated, especially for head injuries caused by low energy trauma, to better capture the nuances of injury severity in different age groups.
