Differences in mortality between elderly and younger adult trauma patients: Geriatric status increases risk of delayed death
Differences in mortality between elderly and younger adult trauma patients: Geriatric status increases risk of delayed death
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DOI：
10.1097/00005373-199810000-00034
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发表时间：
1998-10-01
影响因子：
--
通讯作者：
Trask, AL
中科院分区：
文献类型：
--
作者：
Perdue, PW;Watts, DD;Trask, AL
背景：老年患者创伤后的死亡率高于年轻患者。死亡率增加可归因于年龄、既往疾病、并发症以及损伤严重程度。 方法：对来自 I 级创伤中心的 5,139 名成年患者的记录进行回顾性审查。对老年（大于或等于 65 岁）和年轻（16-64 岁）患者确定损伤严重程度评分 (LSS)、修订创伤评分 (RTS)、早期死亡率（24 小时），通过国际疾病分类第九版修订版临床修改诊断编码确定既往疾病和并发症。结果：尽管损伤严重程度相同，老年患者的死亡率是年轻患者的两倍 (p < 0.001)，并且老年患者比年轻患者更有可能晚年死亡 (p < 0.005)。老年人原有疾病的患病率更高，并发症的发生率也更高。使用逻辑回归，ISS、RTS、先前存在的心血管或肝脏疾病、心脏、肾脏或感染性并发症的发生以及老年状况均可独立预测晚期死亡率（p < 0.05）。结论：由于损伤以及先前存在的疾病和损伤后并发症的增加，老年创伤患者比年轻患者更容易遭受晚期死亡。对老年创伤患者进行积极治疗是必要的；然而，面对严重的先前存在的疾病或并发症，生存的可能性较小。可以开发生存预测模型，同时考虑到先前存在的疾病和并发症以及入院参数（例如年龄、ISS 和 RTS）以及量化的特定死亡风险。
Background: Elderly patients suffer higher mortality rates after trauma than younger patients. This increased mortality is attributable to age, preexisting disease, and complications as well as injury severity,Methods: Records from 5,139 adult patients from a Level I trauma center were retrospectively reviewed. Injury Severity Score (LSS), Revised Trauma Score (RTS), early mortality (24 hours) were determined for elderly (greater than or equal to 65 years) and younger (16-64 years) patients, Preexisting diseases and complications were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis coding.Results: Mortality in elderly patients was twice that in younger patients despite equivalent injury severity (p < 0.001), and elderly patients were more likely to suffer later death than younger patients (p < 0.005), The prevalence of preexisting disease was greater in the elderly, as was the incidence of complications. Using logistic regression, ISS, RTS, preexisting cardiovascular or liver disease, the development of cardiac, renal, or infectious complications, and geriatric status were all independently predictive of late mortality (p < 0.05),Conclusion: Elderly trauma patients more frequently suffer late mortality than younger patients because of the combination of injury and increased preexisting disease and complications after injury. Aggressive treatment of the elderly trauma patient is warranted; however, in the face of significant preexisting disease or complications, survival is less likely. Predictive models of survival can be developed, taking into account preexisting disease and complications as well as admission parameters such as age, ISS, and RTS, and specific risk of mortality quantitated.