Identifying factors predicting outcomes after major trauma in older patients: Prognostic systematic review and meta-analysis

Abstract

INTRODUCTION Trauma is the most common cause of morbidity and mortality in older people, and it is important to determine the predictors of outcomes after major trauma in older people. METHODS MEDLINE, Embase, and Web of Science were searched, and manual search of relevant papers since 1987 to February 2023 was performed. Random-effects meta-analyses were performed. The primary outcome of interest was mortality, and secondary outcomes were medical complications, length of stay, discharge destination, readmission, and intensive care requirement. RESULTS Among 6,064 studies in the search strategy, 136 studies qualified the inclusion criteria. Forty-three factors, ranging from demographics to patient factors, admission measurements, and injury factors, were identified as potential predictors. Mortality was the commonest outcome investigated, and increasing age was associated with increased risk of in-hospital mortality (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03–1.07) along with male sex (OR, 1.40; 95% CI, 1.24–1.59). Comorbidities of heart disease (OR, 2.59; 95% CI, 1.41–4.77), renal disease (OR, 2.52; 95% CI, 1.79–3.56), respiratory disease (OR, 1.40; 95% CI, 1.09–1.81), diabetes (OR, 1.35; 95% CI, 1.03–1.77), and neurological disease (OR, 1.42; 95% CI, 0.93–2.18) were also associated with increased in-hospital mortality risk. Each point increase in the Glasgow Coma Scale lowered the risk of in-hospital mortality (OR, 0.85; 95% CI, 0.76–0.95), while each point increase in Injury Severity Score increased the risk of in-hospital mortality (OR, 1.07; 95% CI, 1.04–1.09). There were limited studies and substantial variability in secondary outcome predictors; however, medical comorbidities, frailty, and premorbid living condition appeared predictive for those outcomes. CONCLUSION This review was able to identify potential predictors for older trauma patients. The identification of these factors allows for future development of risk stratification tools for clinicians. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis; Level III.