Trauma in the very elderly: A community-based study of outcomes at trauma and nontrauma centers
Trauma in the very elderly: A community-based study of outcomes at trauma and nontrauma centers
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DOI：
10.1097/00005373-200201000-00014
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发表时间：
2002-01-01
影响因子：
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通讯作者：
Fallon, W
中科院分区：
文献类型：
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作者：
Meldon, SW;Reilly, M;Fallon, W
背景：很少有研究调查了非常老年人（> 80岁）的创伤结局，这是我们老年人群中增长最快的子集。我们的目的是描述人口统计学，损伤和损伤严重程度的机制非常老年创伤患者和研究创伤中心（TC）的验证和医院死亡率在这个年龄组之间的关联。方法：回顾性队列研究。数据库由1996年全县创伤登记处组成。受试者包括> 80岁的患者。设置包括一级（TCI）和二级（TCII）创伤中心，和急性护理（AC）医院。使用重大创伤结局研究和县特异性风险/结局方程进行z评分分析。此外，逻辑回归模型使用年龄、ISS、到达GCS和TC验证作为预测变量来检查医院死亡率（结局变量）。统计学分析包括描述性统计、方差分析和前向逐步逻辑回归模型（OR; 95%CI）。结果：455例患者，平均年龄85.9（+/-4.8）岁（范围80 - 101）。总死亡率为9.9%。使用z评分分析，TCII时的生存率符合预测（-1.59），而AC的生存率低于预测（-3.41）。在回归模型中，GCS（OR 0.68; CI 0.57 - 0.79）、ISS（OR 1.1; CI 1.05 - 1.2）和AC设置（OR 3.2; CI 1.19.5）预测住院死亡率。在严重受伤患者的一个子集中，TC的结局明显好于AC医院（ISS 21 - 45）（56% vs 8%存活率; p <0.01）。结论：在该人群中，TC和AC设置之间的风险调整结局不同。头部损伤、损伤严重程度和缺乏TC验证与高龄创伤患者的住院死亡率相关。
Background: Little research has examined trauma outcomes in the very elderly (>80 years), the fastest growing subset of our geriatric population. Our objective was to describe demographics, mechanism of injury and injury severity of very elderly trauma patients and examine the association between trauma center (TC) verification and hospital mortality in this age group.Methods: Retrospective cohort study. Database consisted of a 1996 countywide trauma registry. Subjects consisted of patients > 80 years of age. The setting consisted of Level I (TCI) and Level II (TCII) trauma centers, and acute care (AC) hospitals. The z score analysis was performed using the Major Trauma Outcome Study and a county-specific risk/out-come equation. In addition, a logistic regression model examined hospital mortality (outcome variable) using age, ISS, arrival GCS, and TC verification as predictor variables. Statistical analysis included descriptive statistics; ANOVA; and forward stepwise logistic regression model (OR; 95% CI).Results: Four hundred fifty-five patients with a mean age of 85.9 (+/-4.8) years (range 80-101). Overall mortality was 9.9%. Using z score analysis, survival at TCII performed as predicted (-1.59), while AC performed less than predicted (-3.41). In the regression model, GCS (OR 0.68; CI 0.57-0.79), ISS (OR 1.1; CI 1.05-1.2) and AC setting (OR 3.2; CI 1.19.5) predicted hospital mortality. TCs had significantly better outcomes than AC hospitals in a subset of severely injured patients (ISS 21-45) (56% v 8% survival; p < 0.01).Conclusion: Risk-adjusted outcomes, in this population, differed between TC and AC settings. Head injury, injury severity, and lack of TC verification are associated with hospital mortality in very elderly trauma patients.