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A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years


Kalbas, Yannik; Lempert, Maximilian; Ziegenhain, Franziska; Scherer, J; Neuhaus, Valentin; Lefering, Rolf; Teuben, M; Sprengel, Kai; Pape, Hans-Christoph; Jensen, Kai Oliver; TraumaRegister DGU (2022). A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years. European Geriatric Medicine, 13(1):233-241.

Abstract

PURPOSE: The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017.
METHODS: A descriptive analysis of the data from the TraumaRegister DGU$^{®}$ (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002-2005 (1), 2006-2009 (2), 2010-2013 (3) and 2014-2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared.
RESULTS: In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4).
CONCLUSION: Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

Abstract

PURPOSE: The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017.
METHODS: A descriptive analysis of the data from the TraumaRegister DGU$^{®}$ (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002-2005 (1), 2006-2009 (2), 2010-2013 (3) and 2014-2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared.
RESULTS: In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4).
CONCLUSION: Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

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Additional indexing

Item Type:Journal Article, not_refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Gerontology
Health Sciences > Geriatrics and Gerontology
Language:English
Date:1 February 2022
Deposited On:24 Aug 2021 14:37
Last Modified:25 Apr 2024 01:38
Publisher:Elsevier
ISSN:1878-7649
OA Status:Hybrid
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1007/s41999-021-00546-9
PubMed ID:34324144
  • Content: Published Version
  • Language: English
  • Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)