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were grouped into four age groups and their course of treatment and outcome analyzed using univariate
and pending multivariate comparison (SPSS 17.0 software).
Results: In our patient collective, 129 patients (7.1%) were older than 75 years, and 494 patients
(27.4%) were between 50 and 75 years of age. Although comparable with respect to injury severity
(mean ISS 30-33) and age-adjusted APACHE score, there was a significant increase in overall mortality
beyond the age of 50 (75 years: 64.3%),
with age being an independent predictor of mortality. Despite a similar percentage of patients suffering
from head injuries (mean 69%) of comparable severity (mean abbreviated injury score (AIS) 4.36),
mortality of head injuries was highest in patients >75 years (70.2%, p 75 years of age were four times more likely to undergo
comfort therapy only, and only half as likely to undergo craniotomy for intracranial hemorrhage. Patients
> 50 years of age required significantly shorter ICU care than patients below 50 years of age
(e.g., 9 days in patients > 75 years vs. 14 days in patients < 25 years).
Conclusion: With increasing life expectancy and sustained independence, elderly trauma patients
have become a regular occurrence in trauma services. Despite comparable injury severity and physiologic
status upon admission, these patients suffer from disproportionately high mortality rates. Closed
head injuries account for the majority of fatalities, regardless of the timing and extent of therapeutic
measures applied.
38.6
Trauma injury in patients over 80 years old: an epidemiological study
D. Haeni, E. Testa, C. Freuler, A. Kuhrmeier, R. Rosso, C. Candrian, M. Arigoni (Lugano)
Objective: Because of the increasing longevity in our population the amount of elderly injured patients
is constantly growing. This study is aimed to determine the epidemiology of injured patients aged 80
years or more admitted in a regional hospital.
Methods: Data of trauma patients aged 80 and older admitted to our surgical department during the
year 2008 where retrospectively collected. The following epidemiological parameters were analysed
and compared to the literature: social parameters, injury location, complication rate, length of hospital
stay and discharge location.
Results: During 2008 a total of 2783 admissions occurred in our department of general surgery whith
761 patients over 80 years old. 260 of these were admitted because of an injury (12 patients were
admitted more than once) with a sex ratio F:M of 3:1. These patients suffered a total of 374 injuries of
which 54% where fractures, 16% non surgical brain injuries and 30% injuries (contusions, wounds,
etc). The distribution of the fracture location was as follows: lower extremity 55% (of which 89% proximal
femur); upper extremity 27% (of which 47% proximal humerus); axial skeleton 18%. In patients
over 90 years old upper extremity fractures were significantly less frequent than in patients between 80
and 89 years old (15,9% versus 30%). Fractures where treated operatively in 70,5% of the cases. Mean
length of stay was 9,3 days. Complication rate was 35% with a in-hospital mortality of 2,3%. Only 25%
could return directly home while the other patients were discharged in an other institution (rehabilitation
clinic, retirement home, other hospital).
Conclusion: In our region 5,7% of the population is aged 80 and over and in our study this age bracket
accounts for 27,3% of the admissions in our surgical department during 2008. Of this patient population
34,1% were admitted because of a traumatic injury. The frequency of fractures of the lower extremity
(specially proximal femur fractures) is higher than of the upper extremity and increases with age.
Complication is high but reflects the high co-morbidity rate of this population. Because of the low return
to home rate the medical and social care of these patients is not limited to the acute hospital and this
clearly results in a high socioeconomic impact to our society. The results of this study are similar to
other studies.
38.7
Patients, treatment and outcome following polytrauma - everything worse in the elderly patient?
M. Schüepp, C. Attenberger, I. Füglistaler-Montali, F. Amsler, T. Gross (Basel)
Objective: The elderly patient is expected to suffer higher mortality and lower quality of life following
major trauma. We were interested in the possible impact of age on specific patient, trauma, treatment
and outcome characteristics following polytrauma (injury severity score, ISS>16).
Methods: Minimum 2-year follow-up survey of 237 prospectively collected consecutive patients
(42.8+/-20.9 years; 73.4% male; 96.6% blunt trauma; ISS 29.5+/-11.5) at a university center. Univariate
testing (t-test, ANOVA, chi-square).
Results: Median 2.5 years following injury 180 patients had survived (40.2+/-19.9 years, 73% male,
ISS 26.3+/-7.9; 30-day mortality 22.8%). Non-survivors on average were older and more severely
injured (both p