gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2018)

23.10. - 26.10.2018, Berlin

The older polytrauma patient: mortality and complications

Meeting Abstract

  • presenting/speaker Rob de Vries - University Medical Center Groningen, Groningen, Netherlands
  • Inge Reininga - University Medical Center Groningen, Groningen, Netherlands
  • Mostafa El Moumni - University Medical Center Groningen, Groningen, Netherlands
  • Klaus Wendt - University Medical Center Groningen, Groningen, Netherlands

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocAT12-275

doi: 10.3205/18dkou287, urn:nbn:de:0183-18dkou2876

Published: November 6, 2018

© 2018 de Vries 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

Text

Objectives: Elderly polytrauma patients have a doubled mortality compared to their younger counterparts, regardless of injury severity. Still little is known about the causes and factors influencing mortality. The aim of this study is to identify these cause and possible factors. Besides, this study will describe the frequency and nature of in-hospital complications of older polytrauma patients to further clarify the posttraumatic course of the older polytrauma patient.

Methods: In this retrospective study all trauma patients aged 65 years and older with an injury severity score (ISS) of 16 and above admitted in the period 2008-2016 in a Dutch level 1 trauma center were analyzed. All available variables such as demographics, vital signs, lab results and injury characteristics during admission on the emergency room were collected. Predictors for mortality for mortality were identified with Cox regression analysis. Complications were extracted from the medical records and scored according to the Clavien-Dindo classification. Frequencies of severe complications, which required a (re)operation, intensive care admission or led to death were analyzed.

Results and conclusion: A total of 379 patients, of which 38.3% female, with a mean age of 75.6 years were analyzed. The mean ISS was 26.1. De overall in-hospital mortality was 36.1%, for the elderly ageing 85 and older this was 60.8%. Traumatic brain injury and exsanguination were the most frequent cause of death (48.1% and 23.3%). The best early predictors for in-hospital mortality are: age (HR:1.077/year), an international normalized ratio (INR) >1.2 (HR: 1.594/category) and a low Glasgow coma scale (HR: 0.871/score). The most frequent complications which led to death were respiratory failure and multi organ failure (see Table 1 [Tab. 1], Table 2 [Tab. 2], Figure 1 [Fig. 1]).

Traumatic brain injury was common in elderly polytrauma and the most frequent cause of death. Regardless of comorbidities and injury severity, we found age, an INR >1.2 and a low Glasgow coma scale to be the best early predictors for in-hospital mortality. The most common and deadly in-hospital complication is respiratory failure.