Geriatric Trauma: Demographics, Injuries, and Mortality
Geriatric Trauma: Demographics, Injuries, and Mortality
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DOI：
10.1097/bot.0b013e3182324460
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发表时间：
2012-09-01
影响因子：
2.3
通讯作者：
O'Toole, Robert V.
中科院分区：
文献类型：
--
作者：
Keller, Julie M.;Sciadini, Marcus F.;O'Toole, Robert V.
目的：识别老年人在高能量创伤中所受的损伤，并确定哪些损伤与死亡率相关。设计图：前瞻性收集数据库的回顾性研究。设置：学术创伤中心。患者：从2004年1月至2009年6月所有创伤入院数据库中选择的患者。研究人群包括直接从受伤现场入院的患者，这些患者持续高能量创伤，至少有一处骨科损伤，年龄≥ 65岁（n = 597）。干预：回顾人口统计学、创伤标志物、损伤和处置状态。主要结果测量：采用x（2）检验、Student t检验和logistic回归分析进行统计分析。结果：最常见的骨折是肋骨、桡骨远端、骨盆环、面骨、肱骨近端、锁骨、踝关节和骶骨。与最高死亡率相关的损伤是伴有神经功能缺损的颈椎骨折（47%）、C2节段骨折（44%）、股骨近端骨折（25%）、骨盆环骨折（25%）、锁骨骨折（24%）和肱骨远端骨折（24%）。与死亡率显著相关的骨折是锁骨骨折（P = 0.001），足关节（P = 0.001），肱骨近端或肱骨干和肱骨头（P = 0.002），骶髂关节（P = 0.004），远端尺骨（P = 0.002）。老年患者的损伤明显加重，住院时间更长，出院后需要更多的资源，死亡率是年轻人的三倍虽然颈椎、髋部和骨盆环骨折的高死亡率并不意外，但与死亡率相关的统计学损伤是意外的。锁骨骨折等损伤与死亡率有统计学相关性。随着我们的人口老龄化和变得更加活跃，人口统计学可能会获得临床重要性。
Objectives: To identify injuries that elderly sustain during high-energy trauma and determine which are associated with mortality. Design: Retrospective review of prospectively collected database.Setting: Academic trauma center.Patients: Patients selected from database of all trauma admissions from January 2004 through June 2009. Study population consisted of patients directly admitted from scene of injury who sustained high-energy trauma with at least one orthopaedic injury and were 65 years or older (n = 597).Intervention: Review of demographics, trauma markers, injuries, and disposition statuses.Main Outcome Measurements: Statistical analysis using x(2) test, Student t test, and logistic regression analysis.Results: The most common fractures were of the rib, distal radius, pelvic ring, facial bones, proximal humerus, clavicle, ankle, and sacrum. The injuries associated with the highest mortality rates were fractures of the cervical spine with neurological deficit (47%), at the C2 level (44%), and of the proximal femur (25%), pelvic ring (25%), clavicle (24%), and distal humerus (24%). The fractures significantly associated with mortality were fractures of the clavicle (P = 0.001), foot joints (P = 0.001), proximal humerus or shaft and head of the humerus (P = 0.002), sacroiliac joint (P = 0.004), and distal ulna (P = 0.002).Conclusions: Elderly patients present with significantly worse injuries, remain in the hospital longer, require greater use of resources after discharge, and die at 3 times the rate of the younger population. Although the highmortality rates associated with cervical spine, hip, and pelvic ring fractures were not unexpected, the injuries that were statistically associated with mortality were unexpected. Injuries such as clavicle fracture were statistically associated with mortality. As our population ages and becomes more active, the demographic may gain in clinical importance.