Effect on outcome of early intensive management of geriatric trauma patients

Abstract

Abstract Background Despite significant injuries elderly patients (aged 70 years or more) often do not exhibit any of the standard physiological criteria for trauma team activation (TTA), i.e. hypotension, tachycardia or unresponsiveness to pain. As a result of these findings the authors' TTA criteria were modified to include age 70 years or more, and a protocol of early aggressive monitoring and resuscitation was introduced. The aim of the present study was to assess the effect of the new policy on outcome. Methods This trauma registry study included patients aged 70 years or more with an Injury Severity Score (ISS) greater than 15 who were admitted over a period of 8 years and 8 months. The patients were divided into two groups: group 1 included patients admitted before age 70 years and above became a TTA criterion and group 2 included patients admitted during the period when age 70 years or more was a TTA criterion and the new management protocol was in place. The two groups were compared with regard to survival, functional status on discharge and hospital charges. Results There were 336 trauma patients who met the criteria, 260 in group 1 and 76 in group 2. The two groups were similar with respect to mechanism of injury, age, gender, ISS and body area Abbreviated Injury Score. The mortality rate in group 1 was 53·8 per cent and that in group 2 was 34·2 per cent (P = 0·003) (relative risk (RR) 1·57 (95 per cent confidence interval 1·13 to 2·19)). The incidence of permanent disability in the two groups was 16·7 and 12·0 per cent respectively (P = 0·49) (RR 1·39 (0·59 to 3·25)). In subgroups of patients with an ISS of more than 20 the mortality rate was 68·4 and 46·9 per cent in groups 1 and 2 respectively (P = 0·01) (RR 1·46 (1·06 to 2·00)); 12 of 49 survivors in group 1 and two of 26 in group 2 suffered permanent disability (P = 0·12) (RR 3·18 (0·77 to 13·20)). Conclusion Activation of the trauma team and early intensive monitoring, evaluation and resuscitation of geriatric trauma patients improves survival.