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German Congress of Orthopaedics and Traumatology (DKOU 2016)

25.10. - 28.10.2016, Berlin

Old age, co-morbid illness and injury severity affect immediate outcome in trauma patients: a population study

Meeting Abstract

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  • presenting/speaker Peter van Heerden - Hadassah University Hospital, Jerusalem, Israel
  • Dvora Kirshenbom - Hadassah University Hospital, Jerusalem, Israel
  • Miklosh Bala - Hadassah University Hospital, Jerusalem, Israel

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016). Berlin, 25.-28.10.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocPO28-630

doi: 10.3205/16dkou769, urn:nbn:de:0183-16dkou7694

Published: October 10, 2016

© 2016 van Heerden et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objectives: Trauma in the elderly is frequent and is associated with significant mortality, not only due to age, but also to complicating factors: the severity of injury and pre-existing co-morbidity. Our primary objective was to determine whether age, Injury Severity Score (ISS) and pre-existing co-morbidities had an adverse effect on outcome in patients aged 65 and above following blunt trauma.

Methods: We studied 1027 patients ≥ 65 years old who were admitted to our Level I Trauma Center over 24 months following all types of blunt trauma. We collected demographic data, ISS, Glasgow Coma Scale (GCS) at presentation to the Emergency Department, mechanism of injury, pre-existing co-morbidities, length of stay in the intensive care unit and hospital, surgical interventions, complications, and in-hospital mortality.

Results: The mean age of injured patients was 78.8±8.3 years (range 65 -109). The majority of patients had mild injury severity (ISS 9-14, 66.8%). Diabetes, hypertension and coronary artery disease (CAD) were the most frequent co-morbidities in the study group. 13% of patients were receiving chronic anticoagulation treatment of all types, including warfarin in 44 patients (4.3%), or anti-platelet treatment (aspirin, 89 patients, 8.7% and clopidogrel, 5 patients, 0.5%). Multiple co-morbidities ( ≤ 3) were found in 233 patients (22.7%). Death (n=35, 3.4%) was associated with CAD, renal failure, dementia and warfarin use (p<0.05). The addition of a single co-morbidity increased the odds of wound infection to 1.29, and increased the odds of developing sepsis to 1.25. Both age and ISS increased the odds of death to -1.08 and -2.47, respectively.

Conclusion: Our analysis suggests that chronological age alone in the population of patients aged 65 and above is not a robust measure of outcome and more important predictors, such as injury severity, preexisting co-morbidities and medications are accounted for adverse outcome. These patients should be treated as a special population with special considerations and the trauma care should be tailored to meet their specific needs.