Major trauma in elderly patients: Worse mortality and outcomes in an Italian trauma center

• Main Authors: Gabriele Savioli, Iride Francesca Ceresa, Sarah Macedonio, Sebastiano Gerosa, Mirko Belliato, Sabino Luzzi, Alice Giotta Lucifero, Federica Manzoni, Giovanni Ricevuti, Maria Antonietta Bressan
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Series: Journal of Emergencies, Trauma and Shock
• Subjects: elderly patients; emergency room; major trauma; severe trauma; trauma center
• Online Access: http://www.onlinejets.org/article.asp?issn=0974-2700;year=2021;volume=14;issue=2;spage=98;epage=103;aulast=Savioli

Introduction: Major trauma is the leading cause of mortality in the world in patients younger than 40 years. However, the proportion of elderly people who suffer trauma has increased significantly. The purpose of this study is to assess the correlation of old age with mortality and other unfavorable outcomes. Methods: We assessed on one hand, anatomical criteria such as ISS values and the number of body regions affected, on the other hand, hemodynamic instability criteria, various shock indices, and Glasgow Coma Scale. Finally, we also evaluated biochemical parameters, such as lactate, BE, and pH values. We conducted a prospective and monocentric observational study of all the patients referred to the Emergency Department of the IRCCS Fondazione Policlinico S. Matteo in Pavia for major trauma in 13 consecutive months: January 1, 2018–January 30, 2019. We compared the elderly population (>75 years) and the younger population (≤75). Results: We included 501 patients, among which 10% were over the age of 75 years. The mortality rate was higher among the older patients than among the younger (4% vs. 1.33%; P = 0.050). Hemodynamic instability was more common in the older patients than in the younger (26% vs. 9%; P < 0.001). More older patients (44%) had an ISS >16, in comparison with 32% of younger patients (P = 0.01). Conclusions: The elderly showed worse outcomes in terms of mortality, hospitalization rate, hemodynamic instability criteria, and anatomical and biochemical parameters.